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HUGO
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Version: 9 | Date: July 21, 2014
Provider HUGO User Guide
Table of Contents
Admissions ..................................................................................................................................9
Admit To Order (Admit from the Emergency Department) .................................................................... 9
Quick Inpatient Registration ............................................................................................................................10
Admitting to a Specialty Bed from the ED ........................................................................................................11
Admit From an Ambulatory Clinic ....................................................................................................................12
Entering Height and Weight on Admission ......................................................................................................12
Allergies .....................................................................................................................................12
Allergies to be Documented .................................................................................................................. 12
Icons ....................................................................................................................................................... 13
Add an Allergy ........................................................................................................................................ 14
Documenting No Known Allergies ......................................................................................................... 16
Modify an Allergy Entry ......................................................................................................................... 17
To Cancel a Reaction Symptom ............................................................................................................. 18
Change No Known Allergy Entry to a New Allergy ................................................................................ 18
Cancel an Allergy Entry .......................................................................................................................... 18
Review Allergies ..................................................................................................................................... 19
Customize Orders and/or Medication List View .......................................................................... 19
Follow Up on Discharge Summary ............................................................................................. 22
View Follow Up Communication in Discharge Summary ...................................................................... 22
Workflow Example 1 .............................................................................................................................. 23
Labs to be done in house today and now ........................................................................................................23
Workflow Example 2 .............................................................................................................................. 23
Future Order ....................................................................................................................................................23
Ambulatory PowerPlan ....................................................................................................................................24
Workflow Example 3 .............................................................................................................................. 25
Completing an Ontario requisition electronically ............................................................................................25
Workflow example 4.............................................................................................................................. 26
Future Order ....................................................................................................................................................26
Leave of Absence (LOA) Medication Process – St. Joseph’s ........................................................ 27
What is the Same ................................................................................................................................... 27
What is Changed after HUGO ................................................................................................................ 27
What does this Mean............................................................................................................................. 28
Leave of Absence (LOA) Requiring Medication Patient Administration Process (LHSC) ................ 28
Ordering the LOA ................................................................................................................................... 28
Leave of Absence Order – Start/End Date and Time ............................................................................. 28
MAR - Administering Medications .............................................................................................. 29
Medication Reconciliation .......................................................................................................... 30
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Reconciliation Icons ............................................................................................................................... 30
Accessing Medication Reconciliation..................................................................................................... 31
Order and Medication List ...............................................................................................................................31
Best Possible Medication History .......................................................................................................... 31
Accuracy ...........................................................................................................................................................31
Medication History ................................................................................................................................ 32
Order Catalogue when Adding Medication to BPMH ............................................................................ 32
Add a Medication in the BPMH ............................................................................................................. 33
Compliance ............................................................................................................................................ 34
Cleaning Up a Documented Medications by Hx .................................................................................... 34
Expired Prescriptions........................................................................................................................................34
Deciphering the Reconciliation ........................................................................................................................35
Inconsistencies in Medication History .............................................................................................................35
How to Look for Inconsistences .......................................................................................................................36
How to Fix Inconsistences ................................................................................................................................36
Adding a Medication .................................................................................................................................................... 36
Modifying a Medication ............................................................................................................................................... 36
Cancelling a Medication............................................................................................................................................... 37
Duplicate or Similar Orders .......................................................................................................................................... 38
Patient Compliance ...................................................................................................................................................... 38
How to Stop Inconsistences .............................................................................................................................39
Last Dose ..........................................................................................................................................................39
Patient Taking Medication More than Once Per Day with Different Doses .....................................................40
Printing the BPMH ............................................................................................................................................40
Documenting Medication History for a Unknown Medication ........................................................................40
Non-Formulary Tip ....................................................................................................................................................... 41
Add Non-Formulatry Medication Using the Template ................................................................................................. 41
Ordering a Medication when the Medication Cannot be Found in Order Catalogue ......................................41
Admission Reconciliation ....................................................................................................................... 42
Admission .........................................................................................................................................................42
Complete Admission Reconciliation .................................................................................................................43
Formulary v Non-Formulary Medications ........................................................................................................43
Auto-substitutions ............................................................................................................................................45
Patient’s Own Meds .........................................................................................................................................45
Possible Error Messages ...................................................................................................................................45
Allergy Alert ................................................................................................................................................................. 46
Height and Weight Alert .............................................................................................................................................. 46
Medication Alert .......................................................................................................................................................... 46
Differences between the Admission and Transfer Reconciliations ....................................................... 47
Admission Reconciliation .................................................................................................................................47
Transfer Reconciliation ....................................................................................................................................47
Transfer Medication Reconciliation ....................................................................................................... 47
Complete Transfer Reconciliation ....................................................................................................................48
Transfer to Discharge Reconciliation ...............................................................................................................48
Discharge Medication Reconciliation .................................................................................................... 48
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Complete Discharge Reconciliation..................................................................................................................49
Acute versus Maintenance .................................................................................................................... 50
Admissions From Home or a Non-Cerner Facility.................................................................................. 50
Reprint a Prescription ............................................................................................................................ 50
View Reconciliation History ................................................................................................................... 51
Message Center .......................................................................................................................... 51
Proxy Access .......................................................................................................................................... 51
Grant Proxy to Others ......................................................................................................................................51
Accessing an Account to Which You Have Proxy Access ....................................................................... 54
Orders and Results in Message Center .................................................................................................. 54
Orders...............................................................................................................................................................54
Approve........................................................................................................................................................................ 54
Refuse .......................................................................................................................................................................... 55
View Order Proposals Before Approving or Refusing the Order ......................................................................55
Results ..............................................................................................................................................................55
Message Center Results to Endorse Modifications ............................................................................... 56
Order Entry............................................................................................................................... 60
Adding a Medication Order ................................................................................................................... 60
When to Use the Order Comment Tab ............................................................................................................62
Do Not Use the Orders Comments Tab ............................................................................................................62
Help Finding a Medication ...............................................................................................................................62
Medications from Pharmacy ............................................................................................................................62
Additional Precautions........................................................................................................................... 63
Adult vs Paediatrics................................................................................................................................ 63
Allied Health .......................................................................................................................................... 63
Outpatient Allied Health Referrals ...................................................................................................................63
Paper Copy of the Referral Required ............................................................................................................................ 64
STAT Allied Health Referral Orders ..................................................................................................................65
ALC Order Required Fields Leave as To Be Determined ........................................................................ 65
Ambulatory Medication Order as a Prescription ................................................................................... 65
Cancel a Single Lab Order from a Larger Frequency Order ................................................................... 66
To Cancel a Single Lab Order ............................................................................................................................67
Care of the Body after Death ................................................................................................................. 67
CCAC Referral Request........................................................................................................................... 68
Communication Order ........................................................................................................................... 68
Consult Orders Inpatient vs Outpatient Consult/Referral ..................................................................... 68
Consult – Provider Consult Order Process ............................................................................................. 69
Consult to Physician – Nurse/Unit Clerk Workflow ............................................................................... 69
Co-sign Orders ....................................................................................................................................... 70
Cytology Orders ..................................................................................................................................... 71
DI Order - Changes LHSC ........................................................................................................................ 71
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Requested Hospital Field..................................................................................................................................72
Notification to Clinic Space ..............................................................................................................................72
Automatic Fax ..................................................................................................................................................73
No Auto-Notification ........................................................................................................................................74
DI Order - Changes St. Joseph’s ............................................................................................................. 74
Requested Hospital Field..................................................................................................................................74
Notification to Clinic Space ..............................................................................................................................74
Automatic Fax ..................................................................................................................................................75
DI Order – Do Not Activate DI Orders.................................................................................................... 75
DI Order – Placing Diagnostics Imaging Orders ..................................................................................... 75
Change Date and Time to Reflect the Time of the Test ...................................................................................75
DI Tests .............................................................................................................................................................76
Multi Tests on a Patient ...................................................................................................................................76
Ultrasounds ......................................................................................................................................................76
Date and Time for Orders ...................................................................................................................... 76
ECG Orders ............................................................................................................................................. 77
Reoccurring ECG Orders ...................................................................................................................................77
Future ECG Order .............................................................................................................................................77
Ambulatory ECGs .............................................................................................................................................78
EMG Order ............................................................................................................................................. 78
Heparin Order ........................................................................................................................................ 78
Placing the Order .............................................................................................................................................78
Order an Intermittent IV Solution Daily x 5 days ................................................................................... 80
Lab Orders.............................................................................................................................................. 81
Lab Order - Add-Ons .............................................................................................................................. 82
Lab Order – Add on Blood Work ............................................................................................................ 82
Lab Order – Batching Lab Orders ........................................................................................................... 82
Lab Order – Help with Ordering a Lab Test ........................................................................................... 83
Lab Order – If You Cannot Draw Blood .................................................................................................. 83
Lab Order – Insufficient Volume ............................................................................................................ 85
Lab Order – Check for Existing Lab Orders Before Ordering More ....................................................... 85
Lab Order - Request for Repeat Collection or Appended Addition ...................................................... 86
Laboratory Request for Repeat Collection .......................................................................................................86
Scenario: Sample clotted, hemolysed, insufficient quantity, tube broke in centrifuge................................................. 86
Provider Requests to Append (Add) Laboratory Tests to Samples Already in Lab...........................................86
Scenario: Lab work has been drawn and sent to the lab. Provider now requests to add a new test to existing sample
in lab ............................................................................................................................................................................ 86
Lab Order – Tests Requiring a Public Health Requisition ...................................................................... 87
Place Lab External Public Health Requisition ...................................................................................................87
How to Complete Other Tests ..........................................................................................................................89
Labels – Changes to Lab Label Printing.................................................................................................. 89
Labels – Do Not Reprint Old Labels ....................................................................................................... 90
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Label - Printing Solution for Future Lab Orders ..................................................................................... 90
Steps to Order Outpatient Labs within a Power Plan.......................................................................................90
Labels – Reprint a Label ......................................................................................................................... 91
Labels – Required for all Blood Samples................................................................................................ 92
Leave of Absence Order – Start/End Date and Time ............................................................................. 93
MRSA Swabs .......................................................................................................................................... 93
Medication Order – Albumin Orders ..................................................................................................... 94
Transfusion Frequency Field ............................................................................................................................94
Duration Field ...................................................................................................................................................94
Medication Order – Discontinue or Cancel/Reorder ............................................................................. 94
Medication Order – Dose Times Associated with Hourly Frequencies – LHSC ..................................... 96
Medication Order - Saline Lock Flush .................................................................................................... 96
Discontinuing Saline Lock and Flush.................................................................................................................96
Medication Order – Starting or Tapering Medications in Ambulatory.................................................. 97
Medication Order – When Ordering any Medication............................................................................ 99
Orders that Do Not Fire to your Multi-Patient Task List...................................................................... 100
Orders that Fire to Multi-Patient Task List for Ambulatory................................................................. 100
Placing Diet Orders – Use Drop-Down Fields Not Order Comments ................................................... 100
Issue ...............................................................................................................................................................100
Reason ............................................................................................................................................................100
Solution ..........................................................................................................................................................101
Placing Orders on the Correct Encounter ............................................................................................ 101
Placing a Patch Order........................................................................................................................... 102
Add Patch Order .............................................................................................................................................102
Add Removal Order ........................................................................................................................................102
Placing Post Op APS Orders ................................................................................................................. 103
Ortho PowerPlans not Processing Due to Missing Date for a Routine Xray T+1 for Post Op Day 1.... 104
Placing Proposed Orders...................................................................................................................... 105
From a Consulted Physician ...........................................................................................................................105
Order Placed by System ............................................................................................................................................. 105
Tasks Firing to Nursing and Unit Clerk Task List......................................................................................................... 106
Proposed Order Alerts in FirstNet .............................................................................................................................. 106
Proposed Order Reminder .............................................................................................................................106
Quick Check Box for Proposed Ordering ........................................................................................................107
Placing Respiratory Care Orders .......................................................................................................... 107
Placing a Titration Order ...................................................................................................................... 107
Placing the Order ...........................................................................................................................................107
Placing TPN Order ................................................................................................................................ 108
Initial TPN Orders ...........................................................................................................................................108
Changing an Existing TPN Order .....................................................................................................................108
TPN Form in PAED is Not Available at this Time ............................................................................................109
Placing Verbal and Telephone Orders ................................................................................................. 109
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Verbal Orders Start Date and Time ................................................................................................................110
Placing Vitamin Order .......................................................................................................................... 110
PowerPlans .......................................................................................................................................... 111
Add an Order to a PowerPlan with Add to Phase NOT Add ...........................................................................111
Blood Transfusion PowerPlans .......................................................................................................................111
CareSet and PowerPlan (Orderset) ................................................................................................................112
Discharge PowerPlan......................................................................................................................................113
Initiating Discharge PowerPlans ................................................................................................................................ 113
Discontinue PowerPlans .................................................................................................................................114
Discontinue a PowerPlan When You Need to Cancel a Phase of a PowerPlan ........................................................... 114
Discontinue Completed Blood Transfusion PowerPlans ............................................................................................. 115
ECT PowerPlan ...............................................................................................................................................115
Favorites – Check Your Favorites ...................................................................................................................117
Favorites – Do Not Save a Modified Continuous IV within a PowerPlan as a Favorite ..................................118
Favorites - Save PowerPlans as Favorites.......................................................................................................119
Multi-Phase Outpatient Labs PowerPlans ......................................................................................................119
Reviewing the Plan..................................................................................................................................................... 120
Completing Orders within the Phases ........................................................................................................................ 120
Timing Phase.............................................................................................................................................................. 120
Outpatient Lab Phase................................................................................................................................................. 121
Review Your Orders .................................................................................................................................................... 122
Initiating Recurring Plans ........................................................................................................................................... 122
First Laboratory.......................................................................................................................................................... 123
Subsequent Labs ........................................................................................................................................................ 123
Completing Recurring Multiphase PowerPlans .......................................................................................................... 123
Multi-Phase PowerPlans ................................................................................................................................125
No Proposing Functionality ............................................................................................................................125
Oncology Return to Clinic PowerPlan ............................................................................................................125
Return to Clinic Without Imaging............................................................................................................................... 125
Select Return Date ..................................................................................................................................................... 125
Scheduling Phase ....................................................................................................................................................... 126
Follow Up Appointment Labs Phase........................................................................................................................... 127
Return to Clinic With Diagnostic Imaging Required ................................................................................................... 128
Ortho PowerPlans not Processing Due to Missing Date for a Routine Xray T+1 for Post Op Day 1...............130
Issue ........................................................................................................................................................................... 130
Reason ....................................................................................................................................................................... 130
Solution ...................................................................................................................................................................... 130
PowerPlans in Planned State..........................................................................................................................130
Stop Notifications ................................................................................................................................ 131
Soft Stop Notification .....................................................................................................................................131
Hard Stop Notification....................................................................................................................................134
Proposed Orders .................................................................................................................................. 135
Existing Proposed Orders Task .......................................................................................................................135
From a Consultant ..........................................................................................................................................135
Order Placed by System .................................................................................................................................136
Tasks Firing to Nursing and Unit Clerk Task List .............................................................................................136
Proposed Order Alerts in FirstNet ..................................................................................................................136
Proposed Order Reminder .............................................................................................................................136
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Quick Check Box for Proposed Ordering ........................................................................................................137
Quick Orders Page ............................................................................................................................... 137
Ordering Recurrent Transfusions in Outpatient Settings .................................................................... 139
Adding the Plan ..............................................................................................................................................139
Timing and Parameters Phase ........................................................................................................................140
Timing of Infusion Order ............................................................................................................................................ 140
Conditional If/Then Orders......................................................................................................................................... 141
Laboratory Phase ...........................................................................................................................................141
Packed Red Blood Cells and Platelets Phases ................................................................................................142
Completing the PowerPlan.............................................................................................................................142
View Planned PowerPlan ..................................................................................................................... 143
Order Alert ............................................................................................................................... 143
Orders Page.............................................................................................................................. 143
Patient Lists ............................................................................................................................. 144
Build a Location List ............................................................................................................................. 144
Build a Relationship List ....................................................................................................................... 148
Step 1 – Provider Creates a Relationship List .................................................................................................148
Choose Visit Relationships ......................................................................................................................................... 149
Choose Encounter Types ............................................................................................................................................ 150
Step 2 – Provider Grants Secretary Proxy to Relationship Patient List ..........................................................151
Step 3 – Secretary Logs in and Activates List .................................................................................................154
Build a Provider Group List .................................................................................................................. 155
Build a Medical Service List.................................................................................................................. 158
Build a Personal / Custom List ............................................................................................................. 160
Add a Patient to a Custom List .......................................................................................................................163
Method 1 – Patient Search......................................................................................................................................... 163
Method 2 – When a Patient Chart is Open ................................................................................................................ 164
Method 3 – Add From Another Patient List................................................................................................................ 164
Remove a Patient from a Custom List ............................................................................................................164
Print a Custom List .........................................................................................................................................165
PowerPlan Favorites ................................................................................................................. 165
Notification of Plan Modifications ....................................................................................................... 165
Reviewing the Plan .............................................................................................................................. 166
Resaving the Plan ................................................................................................................................. 167
Removing Favorite PowerPlans ........................................................................................................... 167
Prescriptions.............................................................................................................................168
Do Not Print a Duplicate Prescription for the Chart ............................................................................ 168
Non-Medication Template Prescription .............................................................................................. 168
Previous Non-Medication Template ..............................................................................................................168
New Non-Medication Template .....................................................................................................................169
Specific Non-Medication Template ................................................................................................................169
Narcotic Prescriptions.......................................................................................................................... 171
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Placing an Ambulatory Medication Order as a Prescription ..........................................................................171
Prescription on Discharge .................................................................................................................... 172
Print a Prescription for an Inpatient Medication ...........................................................................................173
Print a Prescription Through Juniper ................................................................................................... 175
Print a Prescription Using a Tablet ...................................................................................................... 175
Convert and Print Prescription .......................................................................................................................175
Reprint a Prescription .......................................................................................................................... 175
Printers - Changing Your Default Printer in Windows ................................................................. 177
Windows 7 ........................................................................................................................................... 177
Windows XP ......................................................................................................................................... 178
Thin Clients .......................................................................................................................................... 178
Record Why You Were in a Patient’s Chart ................................................................................ 178
Surgery – Booking your Patient for Surgery.............................................................................. 179
Complete Surgical Procedure Request Form ....................................................................................... 179
Enter Pre-Admission PowerPlan .......................................................................................................... 179
Enter Day of Procedure PowerPlan ..................................................................................................... 181
Add an Order to a PowerPlan .............................................................................................................. 183
Transfers ................................................................................................................................. 184
Print the Transfer Medication Administration Report ........................................................................ 184
Transfer Between Campuses ............................................................................................................... 185
View Laboratory Guides and Tests ............................................................................................186
PowerChart Icon Legend ........................................................................................................... 187
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ADMISSIONS
Admit To Order (Admit from the Emergency Department)
When the admit decision is made, enter the Admit To order on the Emergency
encounter. Then complete Quick Inpatient Registration and complete your admission
orders on the new ED inpatient encounter.
The Admit To order has been modified for patients in the Emergency Department to
gather the information needed to communicate bed request.
This communicates your intention to admit the patient to the Emergency Department
staff as it appears as an icon on the tracking board.
Two new required fields and one optional field have been added.
•
Precautions
•
Patient Attributes
•
Special Unit Needed (optional field)
When selecting Precautions or Patient Attributes, you can multi-select by holding down
the CTRL key and clicking the relevant options.
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Quick Inpatient Registration
1. Close the patient’s chart.
2. Ensure the patient’s name is highlighted on the Patient List.
3. Click the PM Conversation icon and then Quick Inpatient Registration.
4. A pop-up will query “Is this patient being admitted from Emergency?”
5. Click Yes to admit a patient from Emergency.
Yes will keep them in the emergency location and No will put them in a clinic
location.
6. Complete the blank yellow fields.
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7. Click OK.
8. A pop-up will query “Do you want to open the patient’s chart?”
9. Select Yes and this will open the inpatient encounter to the Orders page.
Important
Taking these steps ensures that you are set to place the admission
orders and complete admission medication reconciliation on the proper
encounter type.
Admitting to a Specialty Bed from the ED
1. To request a specialty bed, select a unit using the Special Unit Request drop-down
list.
Important
Prior to completing the Quick Inpatient Registration you must place the
Admit To order on the patient’s ED encounter.
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Admit From an Ambulatory Clinic
1. Call Admitting and request a bed.
2. Close the patient’s chart.
3. Ensure the patient’s name is highlighted on the patient list and click the PM
Conversation icon and then Quick Inpatient Registration.
4. You will be asked if this is an admission from Emergency – choose No.
5. Complete the blank yellow fields in the window that opens (Dx, admit service, admit
provider) and click OK.
6. A pop-up will query “Do you want to open the patient’s chart?” Select Yes and this
will open the inpatient encounter to the order window.
7. Complete the medication history in Document Medication by Hx.
8. Complete admission medication reconciliation.
9. Complete and initiate an admission PowerPlan.
Entering Height and Weight on Admission
It is essential that heights and weights are documented as soon as possible after
admission. These values flow to Pharmacy and are part of the automatic calculations for
weight-based drugs.
The Admission Database PowerForm is the best place to enter the initial height and
weight. This PowerForm is ordered automatically on admission and is found on the Task
List or in the Task section of the PAL.
ALLERGIES
Allergies to be Documented
An Allergy Status alert will appear when allergies have not been documented. You need
to document all three alleriges if known or document all allegeries as Unable to
Obtain/Collect.
Also if food allergies are not documented, the patient will not receive a tray until further
investigation occurs.
The three allergies that must be documented for each patient are;
•
Drug,
•
Food,
•
Environment.
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There are several ways to open the Allergies window to document allergies.
1. There are 3 ways in the Summary ViewPoint
2. In the Admission Database PowerForm, right-click in the Allergies section, choosing
Add New on the menu.
3. In the PAL, double-click the No Allergies documentation icon
for the patient.
Icons
The first icon means that information has been documented about a patient’s allergies;
it does not mean that all information has been documented. The second icon means no
allergy information has been documented. Double-click on the icons to review or enter
information.
Allergy documentation
No allergy documentation
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Add an Allergy
1. Open the Allergy window.
2. Click the Add icon.
3. Ensure Category is set to the allergy you are entering, Drug, Food, Environment.
4. Click the Search tab.
•
The Catalog tab contains folders of common allergies as well as common allergic
reactions. It is important to remember that if you do not find what you are
looking for in the Catalog tab, use the Search tab.
•
Please ensure that you exhaust all search options to select the correct substance
/ reactions from the database.
•
From the Search tab, if you are unsure of a spelling, start by typing just a few
letters when searching. If you still have questions ask a colleague, Google, check
Micromedex or call Pharmacy.
•
For non-medication allergies, try using existing substances and adding
comments. For example: green apple allergy = Substance of apple with
Comments green.
5. Click the Search tab and type in the substance name.
6. Double-click on the found substance to move it to the Substance section.
7. The Reaction type will default to Allergy.
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8. Click the drop-arrow beside the Reaction type field if the type needs to be changed.
9. Click the Catalog tab.
10. Click the + plus sign to expand the Common Allergic Reactions folder.
Important
If you are unable to find a medication substance ask a colleague,
Google, check Micromedex or call Pharmacy. For non-medication
allergies, try using existing substances and adding comments. For
example: green apple allergy = Substance of apple with Comments
green.
11. Double-click the Common Allergic Reaction to move the reaction to the Reaction
symptoms field.
12. Click the drop-arrow to record the relationship of the person who provided the
allergy information.
13. Click Apply, then New when you need to add the other allergies.
14. Click OK when all allergies have been documented.
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15. The green checkmark indicates that the allergy qualifies for cross-referencing with
pharmacy’s drug database.
16. Click OK to return to the patient’s chart.
Documenting No Known Allergies
When documenting allergies it is important to document all three categories of
allergies: Drug, Food and Environment.
If your patient’s has no known allergies in any of the three categories, follow these
instructions.
1. From the table of contents menu, add an allergy by clicking Add.
2. From the Catalog tab, expand the folder for No Known Allergies/Unable to Obtain.
3. Double-click to choose the no known allergy, e.g., NKDA, No Known Environmental
Allergies, No Known Food Allergies.
4. The Substance field will display the no known allergy that was selected.
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5. Click the drop-arrow beside the Category field and choose the associated category,
e.g., Drug, Environment, Food.
6. Click the drop-arrow and choose the correct Info Source - the person who provided
the allergy information.
7. Click the
button to apply this allergy information to the patient’s chart.
8. To add more allergy information, click the
button.
9. When all three categories of allergies have been documented click the
button to return to the patient’s chart.
Modify an Allergy Entry
1. Double-click the substance in the allergy record.
2. The Modify window opens, allowing you to make any necessary changes.
3. Click the
button to save the changes but stay in the window to add a new
allergy if needed or click the
button to save the allergy entry and return to
the patient’s chart.
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To Cancel a Reaction Symptom
1. Right-click on the symptom.
2. Select Cancel.
3. If cancelled in error, right-click again, and select Undo Cancel.
4. Cancelled reactions will be displayed with a red X.
Change No Known Allergy Entry to a New Allergy
If a patient had no known allergies recorded in any of the three categories and then the
patient develops an allergy, you must CANCEL the no known allergy entry before you
can enter the new allergy information.
Cancel an Allergy Entry
1. Click it once and then click Allergy on the menu bar to select Cancel from a pulldown menu, or right-click the entry and then click Cancel from the shortcut menu.
2. You must provide a reason for the cancellation in the Reason: field.
3. Click the drop-arrow beside the Info source field to see the menu options and select
the person who provided the allergy information.
4. Click the
button to save the changes but stay in the window to add a new
allergy if needed or click the
button to save the allergy entry and return to
the patient’s chart.
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Review Allergies
1. You may click the Mark All as Reviewed button once you have reviewed the allergy
record, made any revisions and the record is correct as listed; OR
2. You may select and review individual allergy entries by right-clicking the entry and
selecting Mark as Reviewed.
3. You have now recorded that you reviewed this allergy record and it is correct.
Review information includes the date and time of the review and your name.
CUSTOMIZE ORDERS AND/OR MEDICATION LIST VIEW
You can change the order of columns for Orders and Medication List. You can also
change how information is grouped and sorted.
Important The Orders page is encounter specific while the Medication List crosses
encounters.
Suggested Order of Columns
Orders
Type
Quick Discontinue
Notifications
Order Name
Status
Details
Ordering Physician
Start
Last Updated
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Medication List
Type
Quick Discontinue
Notifications
Order Name
Status
Details
Ordering Physician
Compliance Status
Compliance Comments
Start
Last Updated
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Change Order of Columns
1. In the patient’s chart, click Orders or Medication List.
2. Click Customize View at the far right.
3. The Customize View dialog box opens.
4. Select a column to move.
5. Click the
or
arrows to move the column to the desired location.
6. If necessary, select a column to remove and then click the
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button.
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Change Group and Sort Orders
1. Next, change settings in the Select how you want to group & sort orders section of
the Customize View dialog box for both Orders and Medication List views.
2. Click the drop-arrow beside the Group orders by field and change to Clinical
Category.
3. Click the drop-arrow beside the Then by field and change to Venue.
4. Click the drop-arrow beside the Sort orders by field and select Type and then click
the Descending radio button.
5. Click the
button to save these settings.
Column Information
When you make Type the first column, it shows you icons as a visual expression of the
order type. Here are some examples:
Inpatient order
Home medication
Prescription
Quick Discontinue allows you to see if the order is active (checkmark in grey box). Click
once on a checkmark in the Quick Discontinue column to discontinue the order.
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The Notifications column needs to be close to the front because this is where there
nurse will see nurse review
.
The Order Name, Status and Details columns are usually grouped together.
Sizing Columns
Remember you can adjust the column width by selecting the border line separating two
columns (your mouse pointed will become a two-headed arrow) and dragging until the
column is the desired width.
FOLLOW UP ON DISCHARGE SUMMARY
A provider may also enter a communication when completing a discharge using the
Discharge summary.
Important
This will not appear on your Task list.
View Follow Up Communication in Discharge Summary
1. You must be in the Summaries ViewPoint in the patient’s chart.
2. Click the Discharge Summary tab.
3. Click on the Follow-up widget.
4. Complete all required details.
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5. These will post to the depart summary when printed, and to the Summaries
Viewpoint
Workflow Example 1
Labs to be done in house today and now
1. Patient seen in clinic ,
2. Lab orders entered electronically for today and now;
3. Labels generated; and
4. Patient sent to Lab Test Centre with labels.
Workflow Example 2
Labs to be done in house in the future (not connected to a clinic visit)
Future Order
1. Patient seen in clinic.
2. Provider determines labs to be done later before next clinic visit.
3. The lab order is entered electronically changing the Future Order field to Yes in the
Details tab.
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4. The lab order will appear on Orders profile as Future (On Hold).
5. Clinic provides patient with a “card” with the instructions to go to Lab Test Centre
before next clinic visit.
OR
Ambulatory PowerPlan
1. Patient seen in clinic.
2. Provider determines labs to be done later before next clinic visit.
3. The lab order is entered electronically in a planned state as a Planned PowerPlan.
4. From the Add Order window, change the Type to Ambulatory.
5. In the Find field, type COMMON - Outpatient.
6. Click the COMMON – Outpatient Labs PowerPlan.
7. Click the
button.
8. Click the checkboxes to add the lab tests that you would like to order.
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9. Complete any order details as necessary.
10. Click the
Important
button only.
Do not click the
button.
11. Click Refresh (Minutes Ago).
12. In the View section of the Orders profile you will see the COMMON – Outpatient
Labs PowerPlan in a (Planned) state.
13. Clinic provides patient with a “card” with the instructions to go to Lab Test Centre
before next clinic visit.
Workflow Example 3
Completing an Ontario requisition electronically
1. Patient seen in clinic
2. Provider determines lab work to be done externally.
3. The lab order is entered electronically.
4. From the Add Order window, change the Type to Ambulatory.
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5. In the Find field, type lab - external.
6. Click the LAB – External – Ontario Lab Requisition PowerPlan.
7. Click the Done button.
8. Select the lab orders you wish to order.
9. Click the
10. Click the
button to review the orders.
button.
11. Click Refresh (Minutes Ago).
12. Once signed, the Ontario Lab Requisition prints out.
Important
The provider must manually complete and sign the printed requisition
for it to be accepted by an external laboratory.
Workflow example 4
Bloodwork required in the future on the day of the next clinic visit prior to coming to
the clinic
Future Order
1. Patient seen in clinic.
2. Provider determines labs to be done later before next clinic visit.
3. The lab order is entered electronically changing the Future Order field to Yes in the
Details tab.
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4. The lab order will appear on Orders profile as Future (On Hold).
5. Patient returns to hospital for clinic visit and goes to Central Registration.
6. Patient then goes to clinic and future lab orders are activated by clinic staff (clerk).
7. Labels are generated.
8. Patient sent to Lab Test Centre with labels.
In the event the clinic is unable to activate the orders same day they will need to
keep the future orders on paper.
The reason is that the patient is registered to the clinic and if the Lab Test Centre
activates the future lab order the labels will print out to the location the patient is
registered (the clinic ).
LEAVE OF ABSENCE (LOA) MEDICATION PROCESS – ST. JOSEPH’S
What is the Same
1. Notify Pharmacy.
a. Parkwood – Nurses will continue to complete an LOA Request From – picked up
by or sent to pharmacy.
b. RMHC and South West Centre – Nurses will generate a paper LOA report,
complete and sign as appropriate and fax to pharmacy.
2. The site specific process for dispensing meds for LOAs does not change.
What is Changed after HUGO
1. Pharmacy will not see orders to discontinue medications.
2. There is no alert (a message) to let pharmacists know that an LOA has been
dispensed.
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3. There is a risk that pharmacy may not be aware that there are changes to
prescriptions between the time the LOA request was sent from the unit and the time
it is dispensed in Pharmacy.
What does this Mean
1. Nurses must carefully check the LOA meds dispensed against the patient’s MAR
prior to giving the LOA meds to the client.
2. There may have been changes to the med orders after the LOA was processed.
Important Pharmacy will continue to ensure medications dispensed for LOAs are
accurate and up to date at the point in time the prescription is checked.
LEAVE OF ABSENCE (LOA) REQUIRING MEDICATION PATIENT
ADMINISTRATION PROCESS (LHSC)
This process aligns with the LHSC Corporate Policy PCC081 Patient Leave of Absence
Ordering the LOA
1. Provider to add
to Orders Tab
2. Complete details of Leave of Absence order including:
a. Start date and time
b. Length of time
c. Accompaniment etc. in special instructions.
3. Complete the Leave of Absence-Pharmacy Medication Request order including the:
a. Priority
b. Start date
c. A time
d. Any instructions to pharmacy e.g. 72 hours
4. Initiate the PowerPlan.
Leave of Absence Order – Start/End Date and Time
The Leave of Absence order has a field to identify a Requested Start Date/Time but
there is no field, currently, to identify a Requested Stop Date/Time.
Therefore, please enter the Start and End dates of the leave in the Special Instructions
field of the order details.
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What you type in the Specialist Instructions field appears in the Details column of this
order on the Orders page.
Entering your specific requests dates for a leave will ensure clear directions and
indications to other staff of the status of that patient.
MAR - ADMINISTERING MEDICATIONS
The majority of medications will be administered using closed loop medication
administration – scanning the armband > scanning the medication > administering the
medication > signing. However, you may be required to sign-off medication that you as
a provider have given.
1. Click MAR from the table of contents menu.
2. Find the medication order on the MAR.
3. Click the blue box (if scheduled) or the green box (if PRN) in the administration
column of ondansetron.
4. The Chart Details dialog box opens. Here we can see the full order. It defaults today
and now and the person logged in.
5. Click the Sign
icon to document and close the dialog box.
6. The administration box turns grey and displays the word Complete.
7. Refresh the screen and the administration is now documented under the
appropriate time with that medication on the administration line.
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MEDICATION RECONCILIATION
Medication reconciliation allows the clinician to document a patient’s historical (home)
medications and reconcile medications. Online medication reconciliations are to be
performed by providers only.
Medication reconciliation is accessed from the Orders or Medication List components of
the table of contents menu.
The phases to online medication reconciliation:
1. Medication History (Document by Hx);
2. Admission Medication Reconciliation;
3. Transfer Medication Reconciliation;
4. Discharge Medication Reconciliation.
Initially the status of the three phases will show incomplete as evidenced by blue
exclamation marks. Each new encounter will reset this status bar.
As each step is completed, a green check mark will precede the phase.
Important
Transfer medication reconciliation is to be completed each time a
patient moves from one level of care to another. This is an excellent
opportunity to refresh the patient’s medication regime to reflect
their current and sometimes drastic changes in condition. Please
refer to the policies of the facility in which you are practicing, as well
as the practices of the services between which the transfers are
taking place.
Reconciliation Icons
Icon Icon Description
What the icon means
Blue and white exclamation mark
Work has not yet been addressed
Green check mark
Work has been completed
Blue re-cycling icon
Work is incomplete
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Accessing Medication Reconciliation
Order and Medication List
Medication reconciliation is accessed from the Orders or Medication List components of
the table of contents menu. You can click on Document Medication by Hx.
.
Best Possible Medication History
Accuracy
Completion of the “Document Meds by Hx” page becomes your BPMH. When
completing a Best Possible Medication History, here are a few pointers that may be of
use.
•
Avoid Free-Texting medications and dosages. The information available to
providers at the time of Reconciliation (admission and otherwise) is only as good
as the list of documented medications. The greater the accuracy of the BPMH,
the easier it will be to complete reconciliations.
•
Choosing a drug with an associated dosage in the title, but changing the dosage
in the order details, can be confusing and will not translate properly across the
reconciliation (eg. Venlafaxine (150mg tab), 125 mg, oral, daily). It is appropriate
in these cases to choose medications that have no dosage information
associated with them e.g. choose <NONE> option.
•
The BPMH MUST be completed prior to reconciliations. Without them, the task
is impossible to complete.
•
Not every Med History, or Reconciliation will be presented to you in a clear
concise manner. For example, the pateint may be confused or unable to speak
and no family is present.
•
When the patient leaves your care, the information you’ve provided in your
Discharge Reconciliation will become the new Medication History on their next
encounter. This tells the provider on the patient’s next encounter what
medications they were on when they left the hospital.
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Medication History
When a medication history is unknown or non-existent, the proper method for
indicating this is found in the upper left hand corner of the window.
No Known Home Medications
Only available if the patient has not had
any medications entered into the system
in the past or the patient has no known
home medication.
Unable to Obtain Information
If you are unable to obtain medication
information. The nurse will try to gain
information within 24 hours and if that
time passes a system generated reminder
to readdress BPMH will appear the next
time you log into PowerChart.
Use Last Compliance
Only available if the patient has had a prior
encounter with entries made and the
medications are unchanged since the last
encounter.
Order Catalogue when Adding Medication to BPMH
This medication catalogue includes:
•
Medications (generic and trade names) currently in use in Canada,
•
Vitamin and mineral options, and
•
Many of the frequently used herbals.
This medication catalogue does not include any homeopathic remedies and research
medications.
If you are having difficulty searching a medication please use the following strategies:
•
Check your spelling,
•
Use the generic name as this will yield better results as well as a better translation of
doses and schedules through all types of reconciliation,
•
Call your pharmacist for help,
•
Search and use the nonformulary medication order only when unable to find the
medication.
Search and use medication template only when unable to find the medication or to use
as a placeholder while investigating exactly what the patient is taking, e.g., “I take a pink
pill for blood pressure."
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Medication template cannot be Continued when performing medication reconciliation
as there is no corresponding order. If the medication needs to be continued in hospital
then it needs to be entered as a non-formulary order in the inpatient catalogue.
Add a Medication in the BPMH
1. Click Add in the Document Medication by Hx window.
2. Type the medication in the Find field.
3. Select the medication.
4. Choose the order sentence that best matches what the patient is taking.
5. Click OK.
6. Click Done.
7. Add all required information in Order Details.
8. Click Document History.
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Compliance
1. When completing medication history for your patient, it is important to address
compliance by clicking the Compliance tab.
2. Defaults to Still taking as prescribed.
3. If you change the compliance to Still Taking Not as Prescribed you must enter a
Comment (title will flash), e.g., Still taking but only every second day or only ½ a pill.
Compliance should NEVER be entered in the Details tab or the Order Comments tab.
Cleaning Up a Documented Medications by Hx
Expired Prescriptions
It is not uncommon to find expired prescriptions on a patient’s list of medications. Try to
remove the defunct prescriptions if you feel like it would help to clean up the
Documented Medications by Hx.
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In the above image, only 7 doses of Dalteparin were dispensed well over one month
ago, but the prescription remains. The Dalteparin should be removed, or updated to
reflect changes that might have been made at a follow-up visit. See Cancelling a
Medication to remove a home medication.
Below that order, thirty Hydroxyzine tabs were dispensed, but in contrast, the ordering
details for this medication were specified as being a “Maintenance” dose. The
hydroxyzine needs to be reviewed, to ensure that the patient has either stopped taking
this medication, or that it need to be renewed or modified.
Deciphering the Reconciliation
Due to the workflow of some areas, a patient may have initiated orders for their
encounter prior to having had their Admission Reconciliation. In these cases it is
important for you to know where these orders come from, or how they were generated.
Each medication will have an icon associated with it for that purpose. Some medications
may have multiple icons.
If you are unsure what an icon respresents, hover the pointer of your mouse over the
icons on the left to display a text box describing the icon.
Inconsistencies in Medication History
You may need to makes changes to the history when there are inconsistencies between
the history provided by a patient or care-giver, and what is on record in our online
Medication History.
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How to Look for Inconsistences
1. Review each medication listed in the Medication History
Example, a patient indicates a med is a maintenance medication ie. Beta blocker vs
acute med prescription for antibiotics.
How to Fix Inconsistences
Adding a Medication
1. Click the
button In the upper left hand corner of the screen.
2. Type the medication in the Find field.
3. Select the medication.
4. Click Done.
5. Add all pertinent information.
Modifying a Medication
1. Click on the medication in question.
2. Right-click on the medication.
3. Then click Modify from the shortcut menu.
4. Change all pertinent information in the Details box at the bottom of the screen. In
our example, notice the medication is being changed from q4, to q6 hrs in this
example.
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5. You can hide the order details by clicking the small arrow to the left of the order
details window, and proceed to the next medication that requires your attention.
Cancelling a Medication
If a medication is no longer being used by a patient, or they have, since their last visit,
had the medication discontinued for them by another health professional, the
medication can be removed from the history of active medications.
1. Highlight the medication you wish to stop.
2. Right-click on the medication to a display shortcut menu.
3. Select Cancel DC from the list of options.
4. Choose a Cancel Reason from the drop menu.
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5. Once the details have been completed to your satisfaction, you can again minimize
the details window once again with the small black arrow in the upper left hand
corner.
Duplicate or Similar Orders
Duplicates or similar entries can be challenging to spot immediately. Keep in mind that
the Documented Meds by Hx list will populate medications by category first (i.e. home
meds, the prescriptions) then by alphabetical order.
Important
Please note that if a patient has Lasix and Furosemide entered in their
history, they will both appear. The task of finding duplicates is not
always an obvious one. In that same respect if a patient has a Lipitor
prescription, and home med, they too will appear in each section of the
Documented Meds by Hx, as in the case below.
Patient Compliance
Patient compliance can also be modified. This is used to reflect a self-imposed change in
the patient’s medication regime.
1. Highlight the medication you wish to change.
2. Right-click on the medication to display a shortcut menu.
3. Select Modify on the menu.
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4. Choose an option form the Status menu.
5. Fill in all required fields.
6. Again, you minimized with the black arrow in the upper left hand corner.
When the compliance has been modified it will appear to the right of the medication.
How to Stop Inconsistences
What not to do
Choose the correct function
Re-prescribe a home medication in the outpatient
setting, now both medications have to be
reconciled at discharge.
Convert to Prescription or Convert to Inpatient
Order
Re-prescribe a home medication to increase a
dosage.
Cancel / Reorder
Re-prescribe when the paperwork is lost or the
printer the prescription was sent to is now not
available.
Resend allows you to re-print the prescription
and choose another printer if required
Leave medications no longer used – such as
antibiotics.
Complete to remove medications from the list
Last Dose
When documenting med history it is important to put in the Last Dose in the Order
Details. When completing the Med Rec and converting orders you need to look at the
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schedule, click Review Schedule and pick the next scheduled dose to be given.
Patient Taking Medication More than Once Per Day with Different Doses
If a patient takes 2 pills, one 18 mg and one 3 mg, you must document the medication
per dose in the patient’s medication history, with one showing the 18 mg and one
showing the 3 mg. This will facilitate proper admission medication reconciliation by the
provider.
Printing the BPMH
Facilities may elect to print out a Medication history or BPMH. This is a common need in
cases of inter-facility transfers. This may prove especially useful for patients going to
non-cerner/non-HUGO facilities.
1. Click Task on the menu bar.
2. Click Reports.
3. Place a checkmark in the Transfer Medication Administration box.
4. Click Print.
Documenting Medication History for a Unknown Medication
With a medication template you get to specify the details provided to you by a patient
(or family, or friend) that does not force you to conform to the fields that usually
accompany other templates.
The entries generated through this method cannot be reconciled. They will appear on
the list of medications but will not be matched to any entries in the pharmacy catalogue
of existing or formulary medications.
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Non-Formulary Tip
Rather than using the non-formulary template, please try to find a match in the
catalogue. You can then modify the strength of the med or modify the order sentence.
If you cannot find a medication, call Pharmacy for further assistance.
Add Non-Formulatry Medication Using the Template
1. Click Medication List on the table of contents menu.
2. Click Document Medication by Hx.
3. The Document Medication by Hx window opens.
4. Click the
icon.
5. The Add Order window opens.
6. Type medication template in the Find field.
7. Click medication template from the list of results.
8. Click the
button.
9. Complete the details accordingly, there are no mandatory fields.
10. Click
if you need to add more medications or click the
medications have been documented.
button if all
Ordering a Medication when the Medication Cannot be Found in Order Catalogue
1. Click Add beside Orders on the table of contents menu.
2. Type nonformulary in the Find field.
3. Click nonformulary.
4. The following message regarding Interaction Checking appears.
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5. Click the
button to continue.
6. Click the
button.
7. In the Details fill in all mandatory fields.
8. Click the
button.
9. Refresh the screen.
Admission Reconciliation
Admission
Provided a complete and accurate Medication history, the work of the Admission
Reconciliation is straight forward.
There are two choices.
•
Continue a medication
•
Do Not Contine a medication
With each med you have the option of continuing the medication and altering the
dosage or frequencies by …choose Continue and then on the right side they click on the
medication to bring up the order details to change the appropriate field.
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Notice that the icons now reflect that these are Inpatient medications.
•
Once the medication appears in the right hand column, highlight it, and the
order details will appear in the lower half of the screen. You may need to
increase or improve the visual field of this window by dragging the margin
upwards.
•
From here incomplete order details or details that you need to modify can be
done so easily.
•
Work your way down the list keeping in mind that choosing to continue a
medication is in no way an indication that you are committing to that historical
dosage, schedule, or even route.
Complete Admission Reconciliation
1. Access admission medication reconciliation from the Reconciliation drop-down and
select Admission.
Note: Providers cannot reconcile a patient’s admission medications until the
historical (home) medications have been documented /updated.
2. The providers will have a visual indicator (orange star) next to the medication
indicating the medication has not been reconciled. Also, a numeric indicator (bottom
left) will display with the count of unreconciled orders.
3. The Order Reconciliation window opens and there are two sections:
a. Medications Prior to Admission (historical medications and prescriptions);
b. Medications after Admission Reconciliation (inpatient medications).
4. Take the appropriate action on each medication listed Continue or Do Not Continue.
Note: Continued or Reconciled medications can still be modified to suit the
needs of the patient’s plan of care.
5. When all medications are reconciled and order details are complete, click
.
Formulary v Non-Formulary Medications
In the event that the patient is on a medication that is not stocked at your facility, a red
diamond will appear beside the medication if/when you choose to continue it.
It will generate a new pop-up window that may provide you with some alternatives or
options in ordering a replacement. Drilling down through these folders may yield a
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variety of options that you may find suitable as a replacement for the medication in
question.
•
Green Circles indicate that it is a formulary, or in-stock choice.
•
A Red Diamond indicates a non-formulary choice.
•
Some medications have no replacement options at all.
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Auto-substitutions
Some home medications will be automatically substituted when the decision is made to
continue them in hospital. These Auto-Sub decisions will appear as shown below.
You may at this point choose to accept or decline the substitution, and have the patient
take their own supply of medications.
Patient’s Own Meds
You may choose to order a non-formulary medication for a patient for various reasons.
If it’s the patient’s own medication you must indicate this.
1. In Details, click Yes for Patient’s Own Meds
Possible Error Messages
When using the Reconciliation windows, you may get various error messages.
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Allergy Alert
An Allergy Status notification is no longer a “Hard Stop” alert. It will now allow you to
proceed past the warning.
If you wish to enter an allergy from this warning, you may continue to do so.
1. From the Discern Alert window select the option to document an allergy.
2. You will be taken to a new pop-up window.
3. Right-click anywhere in the blank white area.
4. Select Drug Allergy.
5. You will be taken to the Allergy documenting tool.
6. Once the allergy has been recorded, click OK.
7. Continue to your next task.
Height and Weight Alert
You may also get a notification that the Height and Weight have not been recently
documented on this patient. This is not a “Hard-Stop” Alert, and can be bypassed.
Medication Alert
An “Interaction Checking” message is a notification that the medication you have
entered is not recognized by our pharmacy tools, and will not be able to compare this
entry to the other medications that are ordered for this patient to check for possible
interactions.
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Differences between the Admission and Transfer Reconciliations
Some of the key differences between the Admission and Transfer Reconciliations are as
follows.
Admission Reconciliation
•
Home medications that were initially continued on admission will be grouped with their
in-hospital, carried-over counterparts. You will not get a Radio button for each
medication.
Transfer Reconciliation
•
Home medications that were not continued initially will be blank once again, and left for
you to reconcile.
•
Medications that appear without their “as per home” counterparts were ordered in
hospital.
•
Icons will also appear if the medication was ordered via an initiated plan.
•
Transfer Reconciliations cannot be signed until they are completed.
Important
When you are accepting a Transfer, you may need to D/C medication
from the previous service no longer needed ie. Med Admission first
prior to reconciliation and ordering of new meds.
Transfer Medication Reconciliation
Transfer medication reconciliation is to be completed each time a patient moves from
one level of care to another, e.g. critical care to inpatient unit, pre-op to post-op, or
inpatient unit to long term care, etc. (Please revise per Lori O’Brien’s email)
This is an excellent opportunity to refresh the patient’s medication regime to reflect
their current and sometimes drastic changes in condition. The Transfer Med Rec is
almost identical in appearance to the admission Med Rec.
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Complete Transfer Reconciliation
1. Access transfer medication reconciliation from the Reconciliation drop-down list
and select Transfer.
2. The Order Reconciliation window opens and there are two sections
a. Medications Prior to Transfer Reconciliation (historical medications and
current inpatient orders);
b. Medications after Transfer Reconciliation (new inpatient orders).
3. For each medication, choose to Continue or Do Not Continue.
4. When all medications are reconciled and order details are complete click
Transfer to Discharge Reconciliation
When these changes move from the Transfer to the Discharge Reconciliation you’ll notice
the following changes. These are default settings.
•
Even though some home medications were continued in hospital, then discontinued
on the Transfer, they will once again default to “Continue” on discharge, because
they are home medications. They will appear at the top of the list.
•
In-hospital meds that were marked as “Do Not Continue” on the Transfer will not reappear in the discharge list. They remain discontinued.
Discharge Medication Reconciliation
Three (3) different sections may be displayed:
a. Home Medications – This section shows home medications that have not been
ordered as inpatient medications
b. Continued Home Medications – These are medications that were documented
Home Medications and were continued as Inpatient medications
c. Medications – These are new medication orders started in hospital. Please note:
PRNs and regularly scheduled meds are grouped on the same list.
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Complete Discharge Reconciliation
1. Access discharge medication reconciliation two way:
a. From the Reconciliation drop-down list and select Discharge, or
b. Or, click the (+) in the Medication Reconciliation section of the Discharge
Summary.
2. The Order Reconciliation window opens and there are two sections:
a. Medications Prior to Discharge Reconciliation (historical medications,
prescriptions and inpatient medications);
b. Medications after Discharge Reconciliation (historical medications and
prescriptions).
3. Select the status of the patient’s medications after discharge.
4. For each medication, you must choose Continue After Discharge, Create New Rx or
Do Not Continue After Discharge.
5. Under Medications Prior to Discharge Reconciliation, all the patient’s home
medications, as well as medications taken while admitted, are listed.
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Important
Once again, the Medications After Discharge Reconciliation can be
amended by clicking the Create New Rx radio button.
6. Create New Rx to convert an inpatient medication to a new prescription. If the dose
(or route) needs to be changed from what is currently being administered, you will
be able to modify the order details as needed.
7. Selecting a routing should not be necessary. Computers in your area will be assigned
a default printer. If the route needs to be changed, click the drop-arrow beside Send
To and select the correct location. There may be some areas where there are
multiple printers and selecting the routing will be necessary.
8. To add a new prescription that is not on the medications list, click the
button
in the upper left corner and complete the order details for the new prescription.
9. When all medications are reconciled and order details are complete, click
.
Acute versus Maintenance
If the radio button for Maintenance is selected, you can avoid entering a stop date/time
on the medication you are prescribing. This means that if the prescription becomes
invalid, expired or discontinued, it will need to be removed from the Medication History
manually.
If the Acute button is selected once you have entered a date and time for the
medication to stop, the prescription will automatically fall off the Medication History.
Admissions From Home or a Non-Cerner Facility
1. Using the list of medications (on paper) sent from another facility or brought by the
patient, nursing or Pharmacist completes Documented Medications by History and
reviews with the patient / family. This list needs to reflect the medications the
patient was on at home, prior to the hospital admission. Compliance information
needs to be documented during this step. Pharmacy can be consulted to
review/verify this list if any problems arise.
2. The Provider performs Admission Medication Reconciliation, assessing the need for
each medication, by selecting Continue or Do Not Continue. The provider then
activates these admission orders by selecting the
button.
Discharge Medication Reconciliation – follow the steps described above.
Reprint a Prescription
1. From the Discharge Medications Reconciliation window, right-click on the
medications that needs to be reprinted and select Renew.
2. Make the necessary changes to the prescription.
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3. Once completed you will again have the option to print the prescription via the
Reconcile and Sign button at the bottom of the window.
4. Ensure the old prescription is destroyed.
View Reconciliation History
1. View reconciliation history in the navigation pane of Orders or Medication List).
2. Click the (+) in front of Reconciliation History to expand and view details.
MESSAGE CENTER
From your Message Center you are able to easily view the orders that you need to CoSign as well as the Pools and Proxies that you belong to, or have granted / been granted
access to.
Proxy Access
Proxies allow you to grant another provider or resident rights to your co-sign orders.
If you have been given proxy by another provider, you have rights to perform tasks on a
patient outside of your patient list.
The Proxies tab allows you to access the messages in accounts that you have been
granted access to. It also allows you to manage your account, such as granting or
removing proxy to others.
Grant Proxy to Others
1. Click the Proxies tab from Inbox Summary.
2. To the right of the Proxy: field, click the Manage button.
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3. In the User field, type in the name to whom you want to grant proxy.
4. Click on the binoculars if you need to search for the name.
5. In the Provider Selection window click on the name.
6. Click the OK button.
7. If required, set a Begin Date and End Date when you grant proxy.
8. You can change the date using the up and down arrows, or to set a longer date
range, click the black down arrow to open the calendar.
Important:
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If the person being granted proxy always needs access to your
account, not just for a few weeks or months, set your date to
2100/01/01 and a time of 2359.
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9. To grant access to a specific item, click the item and then click the Grant button.
10. To grant access to all items, click the Grant All button.
11. Click the Accept & Next button.
12. Click the OK button if you are finished granting proxy access.
13. Click the OK button to close the Settings saved successfully message.
14. Under the Proxies Given by Me section, you can now see the accounts you have
given proxy to, including the new resident.
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Accessing an Account to Which You Have Proxy Access
1. Click the Proxies tab.
2. Click the Proxy drop-arrow to choose an account if you have proxy access to more
than one account.
3. All Granted Items will be available.
Orders and Results in Message Center
Orders
1. All verbal, phone and proposed orders entered with your name as ordering provider
will appear in your Orders section of your Message Center Inbox.
2. This is for new, cancelled, discontinued and modified orders that are entered with
the communication type of Verbal with Readback, Phone with Readback and
Proposed orders.
3. You can single-select or multi-select patients.
4. Right-click over one of your selected patients.
5. To clear these orders from your Inbox, you have two choices: Approve or Refuse.
Approve
Please select Approve for any orders that you authorized or would like to accept as
proposed orders.
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Refuse
Please only select Refuse and complete the Reason if it is not your patient, the order
was placed on the incorrect patient, or the order was incorrect.
View Order Proposals Before Approving or Refusing the Order
1. Double-click on the order.
2. On the Order Proposal tab review the order information.
3. Click Accept or Reject button.
4. If the Reject button was selected, fill in all required fields.
5. Click Sign.
Results
1. Any lab work or diagnostic tests entered by you or with your name in the Ordering
Physician box will appear in the Results section of your Message Center Inbox.
2. Double-click the patient’s name to open the results.
3. You have two options: Endorse or Refuse.
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4. Please Endorse any results to acknowledge that you have seen them and will act
upon abnormal values.
5. Please only select Refuse if it is not your patient.
6. The process to refuse is to click Refuse radio button.
7. Choose Not my patient as the Reason.
8. In the To: field, click the small red x to remove the defaulted account.
9. Type refuse and press Enter.
10. Double-click either Refused, Lab Results or Refused, Rad Results.
11. Click the
12. Click
button.
or
.
Message Center Results to Endorse Modifications
1. Open your Message Center.
2. Click the Inbox menu.
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3. Click Management Configuration.
4. Scroll down the list on the left-hand side of the screen until you get to the Results
section and click it.
5. Here you can exclude or include items from the Events section in the middle of the
screen. You can also include or exclude encounter types on the right-hand side of
the screen.
6. To modify the Results FYI section click on the FYI Result Subscriptions tab.
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7. From here you can Unassign the subscriptions that you no longer want by clicking on
the subscription on the right and clicking the
button.
8. You can also create your own subscriptions if you want to be very specific regarding
what orders come to your Results FYI inbox.
9. To do this click on the
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10. Configure your own subscription based on your specific needs including Lifetime or
Encounter Relationships, Event Types (Lab, Radiology, Pathology, etc.) and the
Encounter Types.
11. You need to name the rule – click the Name field and type a name.
12. Click the
button when done.
13. A dialog box alerts you that your settings have been saved successfully.
14. Click the
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ORDER ENTRY
Adding a Medication Order
1. Select the
icon from the table of contents menu.
2. In the Find field of the Add Order window, type the name of the medication to
administer.
3. Select the correct Order Sentence.
4. Click the
button.
5. Expand the Details section of the order by placing your mouse on the border of the
Details pane – your mouse will turn into a two-headed arrow.
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6. With the two-headed arrow visible, click and hold the left mouse button while you
drag the pane up to increase its size.
7. Fill out the mandatory fields below at a minimum
a. *Dose – This field will be automatically filled out based on the dosage entered.
b. Dose Unit – enter the units that the dosage will be administered in.
c. Drug Form – enter the drug form. Ensuring that tab is not entered as a plural.
d. Route of Administration – specify what the route of administration will be.
e. *Frequency – enter the frequency of the dose.
8. If you want the medication to have a stop date then you must complete the
Duration and Duration Units fields.
a. Duration – enter the number of the duration. E.g. if 3 weeks enter 3, the unit will
be entered next.
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b. Duration Unit – based on what was entered in the Duration, select the unit.
When to Use the Order Comment Tab
The Order Comments tab allows the provider to add parameters around the medication
administration, e.g., Hold if SBP is less than 80.
Do Not Use the Orders Comments Tab
Do Not Use the Order Comments Tab for adding stop dates, dose increases, or direction
to add extra orders.
Help Finding a Medication
Pharmacy can help identify if a medication is available to order in the system or if it
needs to be entered as a non-formulary drug.
If you need assistance in placing the medication order, you need to ask a SuperUser or
colleague.
Medications from Pharmacy
Even though orders are sent to pharmacy instantly, they still need time to process them.
Please be patient. Medications cannot be dispensed from Pharmacy until they have
been verified by a Pharmacist. You will know a medication has been verified when the
mortar and pestle icon disappears.
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Additional Precautions
Any health care professional can initiate additional precautions for identified or
suspected infections and conditions and precautions should be initiated as soon as
symptoms of an infection are noted.
Appendix B of the corporate Additional Precautions policy outlines some clinical
syndromes requiring the use of controls pending diagnosis.
Infection Prevention and Control or the Infectious Diseases Consultant should be
contacted if clarification regarding initiating precautions is required.
Adult vs Paediatrics
If your site has both paediatric and adult patients, please select your order carefully and
only pick orders that are for PAEDS when appropriate. For example, some blood
transfusions PowerPlans have Adults, PAEDS and Neonatal as options. Occupational
Therapy and Physiotherapy referrals are available for both adults and paediatrics.
Allied Health
Outpatient Allied Health Referrals
1. From the Order Screen type Outpatient in the Find field.
2. Choose the Outpatient Allied Health Referral Order.
3. There are 2 mandatory fields that need to be completed for this referral
a. Choose a follow up time frame for the patient.
b. Choose an outpatient allied health profession you would like your patient to
follow up with.
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4. Once this order is signed, it is tasked as a communication order to;
•
the Nurse,
•
Medical Secretary,
•
Unit Clerk positions.
5. Depending on the workflow established for the area, one of these positions will print
off this order and then it will be faxed/sent to the outpatient service.
Paper Copy of the Referral Required
1. Scroll on the Orders page to see the Outpatient Allied Health Referral order.
2. Right-click the order and select Print to reprint the requisition and then fax it to the
appropriate department.
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3. The process for booking a patient will continue in the same way as it is today.
Important:
This referral does not go to the task list of the allied health
professional so verbal communication is still encouraged.
STAT Allied Health Referral Orders
Please ensure STAT allied health referrals are followed up with a page to the allied
health professional.
ALC Order Required Fields Leave as To Be Determined
The two mandatory fields are to remain as To be determined. The Social Worker will
modify the order to the most appropriate option when she/he does their review.
Please ensure that the Social Work is checked off in the PowerPlan.
Ambulatory Medication Order as a Prescription
1.
2.
3.
4.
Open the patient’s chart to the Orders page.
Click the
icon.
The Add Order window opens.
Ensure you change the Type field from Ambulatory to Ambulatory (Meds as Rx).
5. In the Find field, type the drug name and select the closest match – it will turn bold
and blue.
6. Select the order sentence closest to the order intended and click the
button.
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7. Click the
button.
8. Complete the order details as required/needed.
9. Make sure that the Send To: field is displaying your default printer.
10. Click the
button and refresh your screen.
Important: Once you click the
default printer.
button, the prescription is printed to your
Cancel a Single Lab Order from a Larger Frequency Order
1. On the Orders page you will see the main lab order (parent).
2. Click the plus sign
(children) orders.
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to expand the main order to see all the daily frequency
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To Cancel a Single Lab Order
1. Right click on the specific lab order (check under details).
2. Click Cancel DC from the shortcut menu.
3. Complete the Cancel Reason field.
4. Click the
5. Click the
button.
button.
6. Once you sign the single order you will see the parent order is still there and the
single child order is canceled.
7. Refresh the screen.
Care of the Body after Death
Please follow the current Care of the Body After Death policy which includes filling out
the death pack and notifying patient registration by phone. This policy will be reviewed
and revised in the coming months to reflect any necessary changes as a result of the
HUGO project.
Discharge medication reconciliation and a discharge order are not required.
However, there are two electronic orders in the system, May Release Body to Morgue,
and May Release Body to Funeral Home. Entering these orders is not mandatory.
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CCAC Referral Request
1. Enter the Request for CCAC Referral order for the patient.
This will not go to CCAC.
2. The order will task to the nurse or clerk to tell them to fill out the form and send it to
CCAC.
Communication Order
The Communication Order is available to use for communicating orders that are not
available in the order catalogue.
Please do not use communication orders to order medications, diagnostic or medication
imaging tests that are available when searched, as they do not link with the department
or existing orderables.
Consult Orders Inpatient vs Outpatient Consult/Referral
Inpatient
Consulting a Physician
Outpatient
Consulting a Physician
•
Use the Consult to Physician
Order.
•
Use the Outpatient Clinic Referral
Order.
•
Call that physician.
•
Nurse/Sec/Unit Clerk will print and
send to referred Physician.
Placing an Allied Health discipline referral
Placing an Allied Health discipline referral
•
Enter the individual referral order.
•
•
Allied Health discipline will receive
an automatic notification of the
referral through PowerChart.
Use the Outpatient Allied Health
Referral order.
•
Nurse/Sec/Unit Clerk will print and
send to referred Allied Health.
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Consult – Provider Consult Order Process
•
Consults between services involve providers working together to provide the best
possible care for our patients. To facilitate this process we have a Consult to
Physician order that helps to relay the pertinent information and directions to the
consulting service so that they know how the attending physician would like to
proceed with any consult orders.
•
When a consult is requested, the admitting team will enter the Consult to Physician
order and contact the provider/service they want to consult.
•
Two options are available for the consulted service:
1. Consult & Implement – Assess the patient and implement any additions, changes
or cancellations to orders.
2. Consult & Suggest – Assess the patient and suggest any additions, changes or
cancellations to orders.
Consult to Physician – Nurse/Unit Clerk Workflow
When the provider places a Consult to Physician order it will task to nurses and unit
clerks to contact the appropriate provider.
1. Nurse/unit clerks see the task on their task list.
2. Consult the on-call list to determine the correct provider to contact.
3. Contact the provider that is being consulted to inform them of the request for
consult.
4. Modify the Consult to physician order as follows:
a. Navigate to the Orders page.
b. Right click on the order and select Modify.
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c. In the Ordering Physician dialog box, enter the name of the provider
ordering the consult in the Physician name field and select Electronic or
Non-Provider as the Communication type.
d. Click the
button.
e. Enter the name of the consultant you contacted in the Requested Consultant
field of the order details.
f. Click the
button.
g. Click the
button and refresh your screen.
5. Complete the task from the task list.
6. Ensure a Consult form is stamped, completed (including service, physician name
and date contact) and placed in the patient’s chart.
Co-sign Orders
1. Physicians will be able to co-sign all orders that need to be co-signed by clicking the
Orders for Cosignature button.
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Cytology Orders
When entering a Cytology order, it is important to choose the correct Order Sentence.
Do not choose None.
If you choose None, no labels will print.
When you choose the correct Order Sentence, it ensures that labels will print.
DI Order - Changes LHSC
With HUGO, you no longer complete paper requisitions for radiological tests performed
at LHSC and St. Joseph’s. This includes Ultrasound, Nuclear Medicine, CT, MRI,
Fluoroscopy, Interventional and General Radiology.
These orders will be entered electronically.
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Requested Hospital Field
1. In the order details, you can change the default between the two hospital sites of
LHSC – UH Main and VH Main - as they are considered the same facility.
2. However, if you require a test done at an external facility, e, g, Woodstock or
Listowel, the provider will need to complete a paper requisition.
Important
Do not change the defaulting location to an external facility – the
order will not route to the correct site.
Notification to Clinic Space
1. If you want the appointment notification to go to the clinic space, and not the
ordering physician’s office, type the clinic name in the Send Appt notification to (if
not Ordering Physician field and click the binoculars icon.
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Tip
When typing in the Send Appt notification to (if not Ordering Physician)
field, type LR, LH or SJH to see clinic names for the various locations –
LRCP, LHSC and St. Joseph’s.
2. From the Provider Selection window, select the appropriate clinic, i.e., LRCP, Clinic 1
and click OK.
Automatic Fax
An automated fax with the appointment details will go to the ordering physician's office
or the clinic space, if the order is scheduled more than 48 hours in advance.
If the order is scheduled less than 48 hours in advance, the Central Bookings office will
contact you directly with the appointment date and time.
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No Auto-Notification
Auto-notification of appointments is not set up for Interventional Radiology VH/UH. The
Booking Clerks in each of these areas will call with the appointment date and time.
DI Order - Changes St. Joseph’s
With HUGO, you no longer complete paper requisitions for radiological tests performed
at St. Joseph’s and Parkwood. This includes Ultrasound, Nuclear Medicine, CT, MRI,
Fluoroscopy, Interventional, BMD, Mammography and General Radiology.
These orders will be entered electronically.
The exception is PET, which has to be ordered using the Provincial paperwork and
remains on paper.
RMHC and SWFMH stay on paper for all diagnostic imaging tests. (Mount Hope is out of
scope for HUGO).
Requested Hospital Field
1. In the order details, Parkwood can change the Requested Hospital field to St.
Joseph’s Main for DI order not done on site.
2. However, if you require a test done at a different facility (LHSC, Woodstock, etc.) the
provider needs to complete a paper requisition.
Important
Do not change the defaulting location to an external facility – the
order will not route to the correct site.
Notification to Clinic Space
1. If you want the appointment notification to go to the clinic space, and not the
ordering physician’s office, type SJH in the Send Appt notification to (if not
Ordering Physician field and click the binoculars icon.
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3. From the Provider Selection window, select the appropriate clinic, i.e., SJHC Pain
Clinic and click the
button.
Automatic Fax
An automated fax with the appointment details will go to the ordering physician's office
or the clinic space, if the order is scheduled more than 48 hours in advance.
If the order is scheduled less than 48 hours in advance, the Bookings office will contact
you directly with the appointment date and time.
DI Order – Do Not Activate DI Orders
Unlike lab orders, please do not right-click on the order and activate a medical imaging
order. The order will be activated by Digital Imaging.
DI Order – Placing Diagnostics Imaging Orders
This section is a reminder from the Radiology Department.
Change Date and Time to Reflect the Time of the Test
Please remember to change the requested date and time to reflect the actual date you
want the tests done. Leave the Requested Date and Time as today if you would like the
test scheduled as soon as possible.
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DI Tests
When ordering DI tests if the body site is not included in the title you may need to input
the individual test to cover all areas you want imaged.
Multi Tests on a Patient
If you want CT Thorax/Abd and pelvis you need to enter 2 tests - CT Thorax and CT
Abd/Pelvis. Radiology bookings have alerts in place to ensure these test are scheduled
together.
Ultrasounds
Pelvic Ultrasounds
OB Ultrasounds
Please add the date of the last known menstrual period in the
LNMP field.
Please add the estimated date of birth into the Order Comments
tab.
Date and Time for Orders
When completing an order, ensure that the start date and time of the order is
appropriate. For example, an order for bedtime placed in the morning should start at
2200 hours not “today and now".
1. In the Details for the order, click the drop-arrow for Requested Start Date/Time.
2. Enter the new date and time.
3. Click the
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ECG Orders
Reoccurring ECG Orders
1. When the provider would like ECGs ordered with a frequency, they are instructed to
use the orderable ECG Nurse order when.
2. This orderable has a free-text field, where the provider can identify the frequency or
criteria with which they want the ECG completed.
3. When a nurse sees the order, it is authorization to enter the actual ECG order at this
frequency.
Future ECG Order
1. Place the ECG order.
2. In the details field, select Future Order Indicator and change the Requested
Date/Time to the desired time.
3. Click the
button.
Rationale: The Requested Date/Time field defaults to the current date and time and
the Future Order Indicator defaults to No. If these fields are not changed the order
goes in the system and automatically notifies the ECG tech to complete the test
today.
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Ambulatory ECGs
For Ambulatory ECG tests please use the Future Order option when sending the patient
to the non-invasive diagnostic cardiology department. Leaving it as an active order will
page the ECG tech to come to your location.
EMG Order
The electronic order is now available. When ordered it will route to the EMG
department for scheduling.
The paper forms still need to be completed and sent to the department.
Heparin Order
Placing the Order
1.
2.
3.
4.
5.
6.
Open the patient chart to Orders.
From the table of contents menu, click Add.
The Add Order window opens.
Search for heparin.
Select the COMMON – IV Heparin Module PowerPlan.
The orderable will turn bold and blue.
7. Click the Done button.
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8. Select the orders you need by using the checkboxes on the left-hand side of the
screen, including either the Hematology or Cardiac Care.
9. Click the check box beside the heparin infusion order you will be using.
10. Next, right-click on the order name and select Modify Planned Order.
11.
12. Complete the beginning unit/kg/hr field by clicking in it and typing a normalized
rate. The actual rate will auto-calculate, based on the weight shown below.
13. Important The patient’s actual weight must be documented for the auto-calculate
to work.
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14. Refer to the Order Comments tab for the heparin nomogram.
15. Once all details are complete, click the Initiate button to active the orders.
16. Click the Orders for Signature button.
17. Review the orders and then click the Sign button.
18. Click Refresh (Minutes Ago).
Order an Intermittent IV Solution Daily x 5 days
Example: Normal saline 1 L over 8 hours for 5 days.
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1. In the Ingredient Details tab, change Infuse Over from 1 hour to 8 hr and Frequency
from once to daily.
2. Click the Details tab.
3. In the Duration field, type 5 and click the down-arrow beside the Duration Unit field
and choose day.
4. Click the
button to sign the order and then refresh the screen.
5. The order will appear on the MAR with a medication task to sign off daily.
Lab Orders
•
Batch your blood work by clicking on the first test dragging the mouse down to
highlight all tests or by holding down the Ctrl key and clicking on the tests.
•
Choose the appropriate Priority.
•
Tests do not need to be individually signed – instead add all desired tests and
then signed off all together.
•
Ensure the Collection Date/Time is correct.
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Lab Order - Add-Ons
•
Lab test can be added on to previous draws/collections that are still in the lab.
•
When you are unsure if the blood has already been drawn, collected, or processed,
the order status will provide you with the information you need to determine if
additional testing can be added.
•
Call 52580 at VH or 35787 at UH to reach the lab.
•
Call 64261 to reach the Specimen and Receiving / Core Lab at St. Josephs.
Lab Order – Add on Blood Work
If a blood sample has already been sent down, and you would like to order more blood
work, you need to call the Lab to find out if the blood work can be added on the samples
already collected. This will decrease the number times a patient is picked.
Do NOT enter these add-on orders in PowerChart > the Lab will enter them.
If it’s not possible to add on to existing samples, you will be asked to enter the order as
a new sample will be required from the patient.
Lab Order – Batching Lab Orders
1. In the Find field, type the desired lab test.
2. Select the lab test which will turn blue after it has been selected.
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3. If another test needs to be order, click in the Find field and type in the desired lab
test.
4. Click the
button when all tests have been ordered.
5. To change the default priority or collection time on all orders, click on the first order,
hold your mouse down and drag down to select all orders.
6. Enter the desired changes.
7. Click the
Rationale:
button.
Many lab tests can be completed from one tube of blood.
Batching blood tests together with the same Collection
Date/Time will minimize the amount of blood drawn from a
patient and the potential for multiple needle picks to access
blood.
Lab Order – Help with Ordering a Lab Test
If you need assistance ordering lab tests, contact your Unit Clerk, Nurses or a SuperUser.
It is important that when you order a lab test with a frequency, that you also include a
Duration and Duration Unit.
Lab Order – If You Cannot Draw Blood
If a blood order has been placed, the labels have been printed, but you are unable to
obtain the specimen, e.g., patient refuses or you cannot access a vein, you need to
cancel and reorder as an electronic order for the next day.
1. Open patient’s chart to the Orders page.
2. Right-click over the blood order and choose Cancel/Reorder.
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3. The Ordering Physician dialog box opens.
4. Complete the physician name field and choose Electronic as the Communication
type.
5. Click the
button.
6. In the order details, set the Collection Date/Time field for the next day.
7. Click the
button.
8. You will see both the cancelled order and the new order on the scratch pad.
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9. Complete any missing details
10. Click the
Important:
, e.g., Cancel Reason.
button and refresh your screen.
Make sure you destroy the old labels.
Lab Order – Insufficient Volume
If the lab calls and asks a nurse to redraw a sample due to insufficient volumes, the
nurse must enter an order for that test and, in the Ordering Physician dialog box,
choose Electronic as the Communication type and include the admitting physician in
the Physician name field.
Lab Order – Check for Existing Lab Orders Before Ordering More
Many patients currently have lab orders on their charts that are scheduled as daily
blood work. Before ordering blood work on a patient, please look at the laboratory
section on the Orders page to ensure you are not duplicating existing orders.
1. You must be on the Orders page.
2. Make sure Display is set to All Active Orders.
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3. Scroll down to Laboratory section.
4. Review all active Orders.
5. All active orders will have a checkmark.
Lab Order - Request for Repeat Collection or Appended Addition
Laboratory Request for Repeat Collection
Scenario: Sample clotted, hemolysed, insufficient quantity, tube broke in centrifuge
1. Lab notifies unit which specific sample/lab order needs to be redrawn.
2. Lab cancels current order sample.
3. Nurse* enters the new order for the repeat draw of specific sample/lab order,
entering the original ordering physician name and communication type “electronic”.
4. Nurse/IV team draws sample, labels appropriately and sends to lab for resulting.
* If this is a difficult draw or a special population, the nurse may speak with provider
if they wish to have the sample redrawn.
Provider Requests to Append (Add) Laboratory Tests to Samples Already in Lab.
Scenario: Lab work has been drawn and sent to the lab. Provider now requests to add a new
test to existing sample in lab
1. Provider to call the lab to append lab work to current sample.
2. If new order is required, lab will request provider to enter.
3. Nurse/IV team draws sample, labels appropriately and sends to lab for resulting.
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Lab Order – Tests Requiring a Public Health Requisition
If a laboratory test requires a public health requisition, that paper needs to be
completed separately on paper and sent down with the specimen.
You need to order what is required for lab tests at one time and sign once.
For those lab tests you do not find within the Ontario Lab Requisition, you can add to
the bottom of the plan under “Other”.
Place Lab External Public Health Requisition
1. Click Add order.
2. Search for the lab order that would require a Public Health Lab for completion.
3. Select the Lab – External – Public Health Requisition PowerPlan.
4. Click the
button.
5. PRINTER has been made mandatory because if the checkmark is removed then the
OLR won’t print anywhere.
6. Check off the lab tests you require.
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7. Click Sign if do not want to change the printer.
8. If you want to change the printer click on (olr)Printer.
9. In the Details, click No and enter the correct printer into the REROUTED PRINTER
field.
10. Click Sign.
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How to Complete Other Tests
This is to be used for orders not found on Ontario Lab requisition.
1. Click Other Test.
2. Click the
button.
3. Complete all missing details.
4. Click the
button.
5. Requisition will print.
Important: This order will only print on the defaulted printer.
Labels – Changes to Lab Label Printing
The build of the Routine collection priority is being changed to ensure Laboratory orders
will honour pre-built collection routes for Inpatient areas. Collection routes are
scheduled hourly runs that group Laboratory orders together and print labels. For
Outpatient areas without these collection routes, Routine T;N will print immediately.
In an INPATIENT area, If you used Routine T;N to print a label immediately for a non-stat
Laboratory order, you will now have to use the priority of Timed with T;N.
Priority options include
AM Routine Default for standard labs in
inpatient areas (excluding critical
care areas).
PM Routine
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Collection date and time
Collection date/time will be set to the next
day at 0300.
Blood will be drawn in AM as per hospital
routine.
Collection date/time will be set to today
for 1300. If the blood work is ordered
after 1300 then the label will batch to the
next printing for printing.
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Priority options include
Routine
Default in ambulatory areas.
For inpatient areas.
STAT
Only for medical emergencies.
Default in Emergency
departments.
Timed
Use for tests that need a specific
time for their draw, for successive
draws or for a label that is required
today and now on the inpatient.
Collection date and time
Collection date/time will be set to today’s
date and the current time. Label will print
immediately.
Collection date/time will be set to today’s
date and the current time. Label will print
for next hour lab collection time, e.g., if
order placed at 0805 label will print at
0815. Order placed at 0825, label will print
0915.
Collection date/time will be set to today’s
date and current time.
Lab labels have STAT printed on them and
are processed by the lab as a STAT priority.
Collection date/time will be entered to the
time that is requested.
Frequency, Duration, and Duration Unit
can be completed to identify recurring
blood draws.
To print a label immediately for a non-stat
laboratory order, use the priority of Timed
with T;N.
Labels – Do Not Reprint Old Labels
Please do not print old labels and put on new blood work. The blood work associated
with these old labels has already been resulted and this is causing issues in our lab.
Ensure that you are printing new labels for new blood work, so that proper results can
be completed on your patient.
Labels - Printing Solution for Future Lab Orders
Some facility locations / devices have a required field to select a lab label printer.
This field can be bypassed when ordering labs within a single phase Power Plan,
allowing the label printer to be selected during the Initiated process. It cannot be
bypassed when placing single lab orders. For this reason, if you are ordering single labs
for a future date/time, and you are working at a PC that asks you to complete the
required field for a label printer, back out of the order and enter your labs orders within
a Power Plan.
Steps to Order Outpatient Labs within a Power Plan
1.
Select a Power Plan. For example, there is a COMMON – Outpatient Labs PowerPlan
that houses most commonly ordered labs. There is also a blank AMBULATORY –
Clinic Orders Power Plan in which users can “Add to Phase” lab orders.
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2.
Complete the PowerPlan, ignoring the required label printer field.
3.
Click the
4.
You will receive a message there are missing required details.
5.
Click the
Please Note:
button to sign the PowerPlan.
button to continue.
If a user is placing a multiphase plan from that same area, this
solution will not work.
Labels – Reprint a Label
1. Open the Orders component of the table of contents menu and find the lab test you
want to reprint the label for.
2. Right-click the order and click Order Information.
3. The Order Information for: window opens.
4. Find the Accession Number and write it down.
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5. Close the Order Information for: window.
6. On the toolbar, click the
icon.
7. The PathNet Collections: Label Reprint window opens.
8. In the Starting Accession field, type the accession number you previously wrote
down.
9. Pick your printer from the Label Printer drop-down and then click the Print button.
Labels – Required for all Blood Samples
It is very important that blood samples not be taken until there is a label for the sample.
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Leave of Absence Order – Start/End Date and Time
The Leave of Absence order has a field to identify a Requested Start Date/Time but
there is no field, currently, to identify a Requested Stop Date/Time.
Therefore, please enter the Start and End dates of the leave in the Special Instructions
field of the order details.
What you type in the Specialist Instructions field appears in the Details column of this
order on the Orders page.
Entering your specific requests dates for a leave will ensure clear directions and
indications to other staff of the status of that patient.
MRSA Swabs
MRSA swabs do not print automatically on direct admits. MRSA swabs will need to be
ordered on these patients as per the LHSC Medical Directive with Dr. Michael A John as
the ordering physician and Medical Directive as the Communication type.
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Medication Order – Albumin Orders
New responses have been added to albumin order detail fields.
Transfusion Frequency Field
In the Transfusion Frequency field, two news responses have been added – Twice and
Other.
Duration Field
In the Duration field, one new response has been added – Not Applicable.
These additional responses will make the ordering of multiple doses within a day less
confusing, e.g., Albumin 5% 500ml times 2 doses.
Medication Order – Discontinue or Cancel/Reorder
1. When you need to change a medication order, please use the Cancel/Reorder or
Cancel DC functionality NOT Modify.
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2. It is also important to expand the Details section of the medication order by placing
your mouse on the border of the Details pane – your mouse will turn into a twoheaded arrow.
3. With the two-headed arrow visible, click and hold the left mouse button while you
drag the pane up to increase its size.
4. This is so that you see the Requested Start Date/Time field clearly, preventing
confusion with medication administration times.
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Medication Order – Dose Times Associated with Hourly Frequencies –
LHSC
A reminder about dose times associated with several of these hourly frequencies. These
are not new frequencies and apply to LHSC. They intentionally skip dose times
overnight.
q1 hour while awake
08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 (skips doses from 23 to 07)
q2 hours while awake
06 08 10 12 14 16 18 22 (skips from 24 to 04)
q3 hours while awake
06 09 12 15 18 21 (skips doses for 24 and 03)
q4 hours while awake
06 10 14 18 22 (skips 02 dose)
q6 hours while awake
06 12 18 (skips 24 dose)
If wanting to give a medication around the clock (ATC) but ok to skip if sleeping, then
these frequencies should NOT be used, as they will skip doses and are not ATC
frequencies.
For medications wanted ATC use q2 hours, q6 hours, etc. and put info about holding
during sleep in the Order Comments. This gives the RN a dose to document against ATC
and the ability to give or hold the dose during the overnight hours depending on
whether the patient is sleeping or not.
Medication Order - Saline Lock Flush
If a patient has a saline lock nursing can enter the saline flush order. It is found in the
system as Sodium Chloride 0.9% flush.
Discontinuing Saline Lock and Flush
Please do not send a Med Request to pharmacy to discontinue a saline lock and/or
saline flush.
This can be done by nursing.
1. Right click on the check mark beside the order.
2. Select Cancel DC.
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3. Enter a Cancel Reason.
4. Click the
5. Click the
button.
button.
6. Click Refresh (Minutes ago).
Medication Order – Starting or Tapering Medications in Ambulatory
1. Once in the patient’s chart, click Orders from the table of contents menu.
2. Click Add.
3. The Add Order window opens.
4. In The Find field, type ambulatory -c (make sure you are searching with
Contains set.)
5. Click the AMBULATORY – Clinic Orders PowerPlan – it will turn bold and bue.
6. Click the
button.
7. Click the Add to Phase icon and then click Add Order.
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8. In the Add Order window, change the Type field to Ambulatory (Meds as Rx).
9. In the Find field, type the name of the medication you are starting or tapering.
10. Choose correct order sentence (or the closest to it).
11. Click the
button to close the Order Sentences window.
12. Click the
button.
13. Complete the Dose, time, Duration: put the # [space] day or week.
14. In the Dispense field ensure number correlates for that duration.
15. NOTE***Special Instructions: [type in here something to the effect “take _mg x
duration, then decrease (or increase) to _mg on date”]
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16. Next, click the Add to Phase icon and then click Add Order.
17. In the Add Order window, change the Type field to Ambulatory (Meds as Rx).
You have to change the Type field every time to Ambulatory (Meds as Rx).
18. Complete again steps 9-15, changing the doses, the duration and the dates and
message in special instructions.
19. For the last decrease, include in the special instructions when to discontinue.
Before initiating and signing, click the
button at the bottom.
Make sure you change the name of it to reflect what it is, for example “Titrating
Quetiapine WR 2014/03/04”.
Adding your initials and the date can help you identify that this is the PowerPlan that
you created in order to find it next time.
20. Click the
button.
21. Click the
button.
22. Click the
Important
button.
When you click the
button, it automatically prints.
Medication Order – When Ordering any Medication
The provider needs to pay attention to the Requested Start Date and Time. You need to
assess the date and time and adjust to Requested Start Date/Time to the Next
administration if required.
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Orders that Do Not Fire to your Multi-Patient Task List
Not all orderables are set to fire a task. The following do not:
•
Dressing changes;
•
Vital signs;
•
Central Venous Pressure (did but we have removed the tasking).
•
Future lab orders;
•
Future MRI, Ultrasound, CT, Nuclear Medicine, General Xrays;
•
Planned PowerPlans (you can view them in the patient’s chart).
Orders that Fire to Multi-Patient Task List for Ambulatory
•
Return to clinic;
•
OP Allied Health referral (referral to OT or PT);
•
OP Clinic referral (referral to another clinic – e.g., Respiratory);
•
Labs if they are entered as today and now (can be found on Specimens to collect
tab).
Important:
Outpatient Allied Health Referrals do not fire a task to the Referrals Task
List of the allied health professional.
Placing Diet Orders – Use Drop-Down Fields Not Order Comments
Issue
Dietary order information is not being transferred from PowerChart to the dietary
software.
Reason
Users are typing dietary information in the Order Comments tab instead of using dropdown fields in the Details tab. Text typed in the Comments tab does not get transferred
to the dietary software.
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Solution
1. Do not use the Order Comments tab when ordering diets.
These comments are not transferred to the dietary software.
2. Use the dropdown qualifier fields on the Details tab to add details to the dietary
order. See below:
Placing Orders on the Correct Encounter
Important
It is important to choose the correct encounter to ensure that orders are
placed to the correct encounter and eliminates the need to cancel and
reorder orders placed on the wrong encounter.
1. The Demographic bar displays the patient’s location and encounter type.
2. To change the encounter you are viewing click the location hyperlink on the
demographic bar to open the Custom Information dialog box.
3. Double click the desired encounter to change encounters.
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Placing a Patch Order
Add Patch Order
1. Click Order’s
from the Table of Contents menu.
2. In the Find field of the Add Order window, type the name of the medication to
administer.
3. Click COMMON – Nicotine Replacement PowerPlan.
4. Enter the Physician name and Communication type.
5. Click the
button.
Add Removal Order
If a patch dosage is continuing from a home med remember to add the removal order.
1. Select the
icon beside Orders on the table of contents menu.
2. In the Find field of the Add Order window, type the name of the medication to
administer.
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3. Select patch removal.
4. Select the correct Order Sentence if applicable.
5. Click the
button.
6. Complete the blank yellow fields
7.
8. Click the
button.
Placing Post Op APS Orders
Multi-phase anesthesia post op orders have three main components:
Phase 1 – PACU Stage One,
Phase 2 – PCA/Neuraxial Opioids (or Epidural),
Phase 3 – Anesthesia Multimodal, Post-Op.
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All phases of this plan will be initiated during the PACU phase of the patient’s care.
Phase 1 PACU Stage One will be discontinued by the PACU nurse once the patient has
met the criteria
Phase 2 & 3 will be discontinued by the APS team pain when they are finished following
the patient.
Important If the PACU phase has not been discontinued before the patient is
transferred to the post op area the inpatient nurse must do so.
Ortho PowerPlans not Processing Due to Missing Date for a Routine
Xray T+1 for Post Op Day 1
Issue
Ortho PowerPlans are not processing because the Requested Date/Time field for a
Routine xray T+1 for Post Op Day 1 in the PowerPlan has been left blank.
Reason
This is occurring because the Requested Date/Time field is not yellow-required. Users
do not realize that it is a required field because it is filled white instead of yellow, and do
not enter a date and time.
When users sign the PowerPlan without entering a date and time for “tomorrow’s”
date, they receive an error message similar to the one below:
Solution
When ordering Routine xray T+1 for Post Op Day 1, ensure you select “tomorrow’s”
date and time, in the Requested Date/Time field as shown below.
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Placing Proposed Orders
As an alternative to Suggested Order PowerPlans, physicians have been given the ability
to propose orders.
Proposed orders will appear with an icon and the status of Proposal. Proposed
orders will also show up in Message Center of the physician it is directed to.
If you see these orders, please keep a watch to ensure the MRP team addresses them.
If the order is urgent please page your team to make them aware of the order(s).
We are working on an alert that will fire when a patient has a proposed order. This alert
also fires a task to nursing and unit clerks to remind them to make sure the order(s) is
addressed by the MRP team.
From a Consulted Physician
Proposed orders from a consultant will now show in a Proposal status on the Orders
page.
The first time a nurse or unit clerk open the patient’s electronic chart after a proposed
order is entered, the system will place an order called Proposed Orders Exist. This order
will fire a task that is viewable for nurses and unit clerks.
Order Placed by System
This order will change to complete when the task is completed but will fire again if the
proposed order is still in place
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Tasks Firing to Nursing and Unit Clerk Task List
This task is meant to alert nurses and unit clerks to notify the admitting team of the
proposed order.
It is recommended that the task is marked as complete after the physician
accepts/rejects the proposed order
Proposed Order Alerts in FirstNet
When a proposed order is placed on a patient’s chart in FirstNet the Proposed Orders
Exist order will be placed by the system and a Proposed Orders icon will appear in
the To Do section on the tracking board
Nursing will be responsible for completing the icon after the proposed order is
accepted/rejected. This will complete the Proposed Order Exists order.
Proposed Order Reminder
1. When opening a chart that has a proposed order the following alert will fire.
2. Click OK to clear the alert – it doesn’t accept the proposed order.
If you are not part of the MRP team and this proposed order is not within your decisionmaking scope to accept or reject, disregard this alert.
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Quick Check Box for Proposed Ordering
When you have selected a
Placing Respiratory Care Orders
For all blood gas orders, please call when the order is placed and call RRT to collect.
For all RRT related requests please continue to page as you have previously.
Placing a Titration Order
Placing the Order
1.
2.
3.
4.
5.
Open the patient chart to Orders.
From the table of contents menu, click Add.
The Add Order window opens.
Search for and select the desired drug.
The orderable will turn bold and blue.
6. Click the Done button.
7. On the order Details tab, complete appropriate fields, including Titration Range,
Titration Range Unit, titration instructions, and vital parameters.
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8. Click the Sign button and then click Refresh.
Placing TPN Order
Initial TPN Orders
Search and select the COMMON – Total Parenteral Nutrition (TPN) (Module)
Changing an Existing TPN Order
Search and select the TPN Fluid – Adult order.
Important
DO NOT change the TPN medication order.
DO NOT enter as a Communication Order
The TPN Adult PowerForm will open and the yellow fields must be completed.
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The TPN-Fluid order will show up in the Diet section of the Orders page. This order
tasks to a Pharmacy task list for them to enter the order in PharmNet. It will not
immediately show up as a medication on the MAR.
This order has an associated PowerForm that can be viewed in the Clinical
Documents/Reports and in Form Browser from the table of contents menu.
When the task is completed by Pharmacy its status will change to Completed and the
order will not show on the All Active Orders list.
Once the TPN order is entered in PharmNet the medication will appear on the Orders
page under the IV Solutions section.
The TPN will also then show on the MAR as follows:
TPN Form in PAED is Not Available at this Time
PAED Dietitians must call Pharmacy to notify them that they have completed the form.
Pharmacy will then view the form of the Clinical Documents/Reports page.
Placing Verbal and Telephone Orders
There will always be times when verbal/phone orders are appropriate:
•
A urgent situation for a patient,
•
A physician is scrubbed in to a case/procedure,
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•
A call for changes to existing orders in the night,
•
The physician is travelling,
•
The physician is in a setting where no computer is available.
You need to keep provider engaged until verbal or telephone order is signed, so he/she
can address any alerts that might fire.
Please refer to the Telephone and Verbal Orders policy for further information.
Verbal Orders Start Date and Time
When completing verbal orders with readback, ensure that the start date and time of
the order is appropriate. For example, an order for bedtime placed in the morning
should start at 2200 hours not "today and now".
1. In the Details for the order, click the down-arrow for Requested Start Date/Time.
2. Enter the new date and time.
3. Click the
button.
4. Click Refresh (Minutes ago).
Placing Vitamin Order
When ordering vitamins, change from the defaulted Contains to Starts with to limit
your search results to orderables that start with the word “vitamin”, as opposed to
orderables that contain the word “vitamin”. See examples below.
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Please remember to change back to Contains on your next order.
PowerPlans
•
Do not choose a label printer.
•
Batching of blood work can only be done after you have initiated the orders.
•
Be mindful of the date when ordering labs for AM Routine as they will be
scheduled to print for tomorrow’s date, e.g., watch to see if it is after midnight
or before midnight
Add an Order to a PowerPlan with Add to Phase NOT Add
1. When adding an order to a PowerPlan prior to placing it in a Planned state, be sure
to click Add to Phase icon and not the Add icon.
2. Click Add to Phase and then click Add Order to open the Add Order window.
3. Search for and select the order and click Done.
4. Enter the order details and Sign and Refresh.
If you have generated your lab labels and you require an additional lab test - you
must contact the Lab Department. They will guide you on how to enter the
additional test.
Blood Transfusion PowerPlans
Once the last product associated with a BLOOD TRANSFUSION PowerPlan is infused,
nurses need to discontinue the PowerPlan to discontinue the remainder of the orders,
e.g., the continuous IV order.
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Blood products are only available to order within the BLOOD TRANFUSION PowerPlans.
Providers may choose to use the Full Protocol or the Product Only.
Using the PowerPlan will task the transfuse order to the nurse.
Blood Transfusion PowerPlan have been added to the Blood/Tissue products order
folder.
To view pending blood product orders and/or product availability click Blood Product
Information on the Table of Contents menu in the patient’s chart.
This is new for Albumin, IVIG and Rh Immune Globulin.
•
The Blood Transfusion Lab will assign the total number of vials / grams that were
requested in the physician’s order.
•
The order will be completed because the blood product is now available for
pickup.
•
The nurse needs to send a PickUp order for the appropriate time and NO more
than 1 days’ worth of albumin or IVIG should be requested at one time.
This change to Albumin, IVIG, and Rh Immune Globulin will now be consistent with ALL
other blood products.
In the Blood Product Information (BPI) page, there will be either a;
•
Pending Order or,
•
The product will be assigned to the patient and be viewable in the Available
Section of this page.
Important
For infusion details like rate of infusion, frequency etc .the order
itself will need to be reviewed and when appropriate, copied onto
the Kardex and/or scratch pad day’s worksheet.
CareSet and PowerPlan (Orderset)
Caresets
are a set of orderables, usually lab and radiology, placed together for
ordering convenience.
An Orderset (PowerPlan)
is a more robust set or orderable including medications,
patient care orderable, labs and radiology, and referrals.
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Important CareSets cannot be saved in a PowerPlan nor can other PowerPlan modules
be save into a PowerPlan as a favorite.
Discharge PowerPlan
1. Please use the COMMON – Patient Discharge (Module) and not the single Patient
Discharge order when discharging your patient.
Rationale: The PowerPlan includes other discharge orderables that may be required to
facilitate the patient’s discharge.
2. All the orders in the COMMON – Patient Discharge (Module) fire to nurse and unit
clerk as tasks to complete.
Initiating Discharge PowerPlans
1. To clearly communicate pending discharges please remember to Initiate and Sign all
Discharge Power Plans.
2. If the discharge is for a future date then the Requested Date/Time can be changed
to reflect the desired discharge date, as shown below:
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Discontinue PowerPlans
1. When discontinuing PowerPlans, right-click on the desired plan and select
Discontinue.
2. The Discontinue dialog box opens identifying the order to be discontinued.
3. Check the boxes beside the order you want to keep or leave them all unchecked to
discontinue the entire plan.
4. Click the
5. Click the
6. Click the
button.
button.
button and refresh (Minutes ago).
Discontinue a PowerPlan When You Need to Cancel a Phase of a PowerPlan
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To ensure all orders on a phase are cancelled, it is best to discontinue the complete
PowerPlan and then re-enter it. For example, the LAB - Group and Screen PowerPlan.
Discontinue Completed Blood Transfusion PowerPlans
Issue
Too many orders appear active on the chart. For example, all blood products in a Power
Plan have been infused, but supporting orders (multiple vital signs) are still ordered on
the chart.
Reason
Nurses not realizing they may discontinue Power Plans when all components have been
completed.
Solution
When all components of the Power Plan are complete, including post-transfusion
bloodwork:
1. Right-click on Power Plan in the View pane and select Discontinue.
2. In the Ordering Physician dialog box, enter the MRP name and choose Non Provider
as the Communication type.
ECT PowerPlan
1. Under the Orders section of the table of contents menu, select Add.
2. Search for the MENT HLTH - Electroconvulsive Therapy (ECT) Treatment PowerPlan.
3. Click the PowerPlan and then click the
button.
4. Right click on ECT Lead Placement and select Modify Planned Order.
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5. Complete the Requested Start Date/Time, Number of Treatments and ECT Lead
Placement fields.
6. In the Special Instructions field, enter the Treatment Number, the number
Consented Treatments and the number of Total Lifetime of treatments.
7. Click the
8. Click the
9. Click the
button.
button.
button to initiate the orders and refresh the screen.
10. Review patient medications.
11. Right click on medications that you want to put on hold due to ECT and select
Modify.
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12. Under the Order Comments tab of the medication, type instructions for holding that
medication due to ECT in all UPPER CASE LETTERS.
13. Once you have added the comment to all medications that you want on hold, click
the
button.
14. Click the
button and refresh your screen.
Important: Add these comments to any medications that are order after initiating the
Power Plan as well.
15. Nursing will now see your order comments on the MAR.
Favorites – Check Your Favorites
As you have become more familiar with the process of ordering this might be a good
time to revisit any favorites that were saved early on to ensure that the order details
have been completed correctly.
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When accessing shared favorites, you need to review the order details before saving to
ensure that they are ordered correctly.
The following PowerPlans are available:
1. LAB - Group and Screen STAT (UH)
2. LAB - Group and Screen STAT (VH)
Please take the necessary steps to ensure providers are aware of these new PowerPlans.
Favorites – Do Not Save a Modified Continuous IV within a PowerPlan as a Favorite
If you modify continuous IV solutions, the modifications do not carry across when you
have modified them and save as a favorite.
The issue arises when you try to use this saved favorite (with the modified continuous IV
infusion) on an ambulatory encounter.
Here is the problem
1. You modify the continuous IV solution in a PowerPlan and then click the
button.
2. You open a patient’s chart on an ambulatory encounter (this does not occur on
inpatient encounters).
3. You open the Orders page and find your favorite.
4. When you go to sign the order you will notice the line with the continuous is blank.
Important: If you modify a continuous IV solution within a PowerPlan – do not save as
a favorite – modifications will NOT carry across.
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Favorites - Save PowerPlans as Favorites
1. It is not recommended that providers save prebuilt PowerPlans at this time as they
are subject to changing in the early days of the conversion.
2. However, if you do alter and save a PowerPlan you must be mindful when you
reorder it that you are on the correct encounter type.
Example:
When altering the continuous infusion rate on a PowerPlan it will not
sign correctly if ordered on an ambulatory encounter (see tip above).
Multi-Phase Outpatient Labs PowerPlans
1. In the Find field, type common – re.
2. Click to choose the COMMON – Recurrent Outpatient Labs PowerPlan.
3. The Add Plan window opens.
4. Change Confirm Outpatient Labs Start Date/Time date to the date you would like to
begin the labs.
5. In the Confirm Phase Action section, click the drop-arrow in the Action column and
change the Outpatient Labs to Order Now.
Important
Do not modify the Action field of the Timing phase. This is required to
ensure the plan will be available on the next visit.
6. Click the
button to close the Add Plan window.
7. Click the
button to close the Add Order window.
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Reviewing the Plan
The Common – Recurrent Outpatient Labs plan has two phases within it. The phases
are: Timing (Future Pending) and Outpatient Labs (Initiated Pending).
The phases of the plan can be found in the View section of the Orders page.
Completing Orders within the Phases
1. The PowerPlan will open with the first phase of the plan – Timing (Future Pending).
2. Check Timing of Laboratory.
3. The
indicates that order details are incomplete.
4. Right-click on the order and click Modify.
5. Complete order details as described below.
Timing Phase
If the PowerPlan will be used across multiple encounters it will have a section that
provides direction on the frequency and total duration of the labs. The Timing phase
provides these instructions to the unit for the duration of the testing of labs.
1. Select the appropriate timing details for the Frequency and Duration of the order.
2. Type any additional details in the Special Instructions field.
3. The example below shows the patient needing blood work weekly for a total of 26
weeks on Mondays.
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Outpatient Lab Phase
1. In View section, click the next phase of the PowerPlan Outpatient Labs (Initiated
Pending).
2. Check the appropriate orders.
3. Complete any incomplete order details, as required.
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Review Your Orders
1. In View section, click Common – Recurrent Outpatient to review all orders for
the plan at once.
Important The Timing phase will stay in a Future Pending state for the duration
of treatment.
2. Once all orders are complete click the
3. Click the
button.
button and refresh your screen.
4. Orders are now dispatched.
Initiating Recurring Plans
1. First confirm that the lab testing is required based on the Timing of Laboratory
instructions.
2. Right-click the Timing of laboratory order and select Order Information.
3. The Details tab displays the frequency of the labs and includes the stop date for
the recurring testing.
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Do not click the
button of the Timing phase. This phase must remain in
a Future status to be viewable on the patient’s return visit.
First Laboratory
If this is the first lab, initiate the Outpatient Labs phase of the PowerPlan as per
previous instructions.
Subsequent Labs
For subsequent labs, the desired phase will need to be copied prior to being
initiated.
1. Find the appropriate plan in the View section of the Orders page.
2. Right-click the Outpatient Labs phase that is required and click Copy from the
shortcut menu.
3. A second phase in a Planned Pending status is now available.
4. All orders in the copied Planned Pending phase are an exact copy of the
patient’s earlier lab tests. Including all instructions.
5. Click the
button as per previous instructions followed by the
button to review all the orders.
6. Once reviewed, click the
button.
7. The desired phase is now ordered and the Lab labels will print.
Completing Recurring Multiphase PowerPlans
Once the last set of labs has been done on the stop date of the timing order the plan
may be completed.
It is important to discontinue the Timing phase when the plan is completed to ensure
that the recurrent PowerPlan does not continue past the intended duration of
treatment.
1. To discontinue the plan, right-click on the Timing phase and select Discontinue from
the shortcut menu.
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2. A Discontinue dialog box opens and displays the timing orders being discontinued.
Do not check the box preceding the order (in the Keep column) as orders selected
will not be discontinued.
3. Click the
button.
4. Click the
5. The
button.
indicates that order details are incomplete.
6. Click the
icon.
7. A cancel reason is required to discontinue the phase.
8. Click Order Completed.
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9. Click the
button and refresh the screen.
10. The PowerPlan is completed and will no longer be available on the patient’s return
visit.
Multi-Phase PowerPlans
To understand more about Multi-Phase PowerPlans, please see the following quick
guide:
https://apps.lhsc.on.ca/regional/training/powerchart/assets/HUGO/JobAids/QUICKGUI
DECPOEMultiphasePowerPlans.pdf
No Proposing Functionality
PowerPlans cannot be proposed.
Oncology Return to Clinic PowerPlan
Return to Clinic Without Imaging
1. Click the ONC – Return to Clinic or ONC – Return to Clinic – Chemotherapy
PowerPlan from the Add Order window.
2. The ONC – Return to Clinic – Chemotherapy PowerPlan is to be selected for any
patient currently receiving Systemic or Oral chemotherapy.
Select Return Date
1. The Add Plan window will open, prompting you to select the estimated date of
scheduling the next appointment.
2. After selecting the appropriate number of weeks or months, the Est. start date will
automatically populate.
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3. If Diagnostic Imaging is not required, change the Phase Action from Order Now to
Do not order by clicking the down-arrow.
4. Click OK.
Scheduling Phase
1. The PowerPlan will open to the Scheduling Phase.
2. Click the appropriate return to clinic disease site.
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3. Type the Reason for Exam/Visit in the scheduling order.
Follow Up Appointment Labs Phase
1. Click the Follow Up Appointment Labs Phase from the Orders View.
2. Click the labs you would like completed at the next follow up appointment.
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3. When complete click the
4. If all orders are correct click the
button to review all the selected orders.
button.
Return to Clinic With Diagnostic Imaging Required
1. Click the appropriate Return to Clinic PowerPlan as per previous instructions.
2. Keep the Diagnostic Imaging Phase Action as Order now.
3. Select the appropriate scheduling appointment, completing the Reason for
Exam/Visit and selecting Yes for Follow up Diagnostics required?
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4. Click the Diagnostic Imaging Phase from the Orders View.
5. Click the appropriate diagnostic imaging and complete all the required details.
6. In the details, select the appropriate clinic for the appointment notification to be
sent.
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7. Complete the Follow up Appointment Labs Phase as per previous instructions.
8. When complete click the
9. If all orders are correct click the
button to review all the selected orders.
button.
Ortho PowerPlans not Processing Due to Missing Date for a Routine Xray T+1 for Post Op
Day 1
Issue
Ortho Order Sets are not processing because the Requested Date/Time field for a
Routine xray T+1 for Post Op Day 1 in the Order Set has been left blank.
Reason
This is occurring because the Requested Date/Time field is not yellow-required. Users
do not realize that it is a required field because it is filled white instead of yellow, and do
not enter a date and time.
When users sign the Order Set without entering a date and time for “tomorrow’s” date,
they receive an error message similar to the one below:
Solution
When ordering Routine xray T+1 for Post Op Day 1, ensure you select “tomorrow’s”
date and time, in the Requested Date/Time field as shown below.
PowerPlans in Planned State
We are implementing a new rule for planned PowerPlans, including Suggested Orders
PowerPlans so that a pop-up window will show up whenever Providers, RNs, RPNs or
Unit Clerks open a chart.
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In addition, an order will be entered that has a task associated with it that will show up
for RNs, RPNs, and Unit Clerks so that they are aware the provider has entered the
planned PowerPlan.
Nursing staff either need to address the planned plan or call the Attending physician or
someone from their team so that they can review the Suggested Orders plan an initiate
it if appropriate with any changes/deletions that they deem appropriate.
The alert will look very similar to this:
Stop Notifications
Soft Stop Notification
1. In this example you saved a favorite of COMMON Nausea and Vomiting with oral
metoclopramide pre-checked and dose set as different from standard plan.
2. The PowerPlan/Orderset team made a soft stop change to metoclopramide ORAL
and it is now only available (IV or) subcutaneous. Other medications also prechecked: ondansetron and haldol.
3. The Plan Favorite Notification dialog box opens to let you know of these changes.
4. Click Continue.
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5. This second message populated by system displays.
6. Click the
button and then click the
button.
7. Your favorite appears with the pre-checked metoclopramide ORAL unavailable and
replaced with an unchecked metoclopramide subcutaneous. Now you know the
metoclopramide has been changed, so will pay special attention to the ordering of
maxeran.
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8. Next you need to save and override your favorite with the same name.
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9. The Plan Favorite Notification dialog box will continue to appear until you have resaved your favorite plan.
10. When re-saving your favorite plan, you will receive a dialog box that says there is
already a plan that exists do you want to override.
11. Make sure you click the
button.
Hard Stop Notification
1. The PowerPlan/Orderset team made a hard stop change to metoclopramide ORAL.
2. Click the
button and you will be taken out of the Add Order window and
back to current Orders page.
3. Click the
button and the PowerPlan becomes the blank standard plan again
and the Favorite plan is unrecoverable.
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Proposed Orders
As an alternative to Suggested Order PowerPlans, providers have been given the ability
to propose orders.
Proposed orders will appear with an icon and the status of Proposal. Proposed
orders will also show up in Message Center of the provider it is directed to.
If you see these orders, please keep a watch to ensure the MRP team addresses them.
If the order is urgent please page your team to make them aware of the order(s).
We are working on an alert that will fire when a patient has a proposed order. This alert
also fires a task to nursing and unit clerks to remind them to make sure the order(s) is
addressed by the MRP team.
Existing Proposed Orders Task
1. When a proposed order has occurred, the nurse will receive a notification saying
that there is a proposed order that needs to be reviewed. This task will stay on the
chart even after the provider has reviewed and accepted or rejected the proposed
order.
2. To verify whether a proposed order has been reviewed or not, go to the Orders page
and look for any orders that have a blue question mark icon and in a Proposal
status.
3. If there is still a proposed order on the chart, investigate if the team has been
alerted. If they have not been alerted then alert the team of the presence of the
proposed order. Leave the existing proposed order task in a pending state.
4. If there is no proposed order to be found on the Orders page then the proposed
order has already been reviewed and addressed. Complete the existing proposed
orders task so that it may fire again when new proposed orders are placed.
From a Consultant
Proposed orders from a consultant will now show in a Proposal status on the Orders
page.
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The first time a nurse or unit clerk open the patient’s electronic chart after a proposed
order is entered, the system will place an order called Proposed Orders Exist. This order
will fire a task that is viewable for nurses and unit clerks.
Order Placed by System
This order will change to complete when the task is completed but will fire again if the
proposed order is still in place
Tasks Firing to Nursing and Unit Clerk Task List
This task is meant to alert nurses and unit clerks to notify the admitting team of the
proposed order.
It is recommended that the task is marked as complete after the provider
accepts/rejects the proposed order
Proposed Order Alerts in FirstNet
When a proposed order is placed on a patient’s chart in FirstNet the Proposed Orders
Exist order will be placed by the system and a Proposed Orders icon will appear in
the To Do section on the tracking board
Nursing will be responsible for completing the icon after the proposed order is
accepted/rejected. This will complete the Proposed Order Exists order.
Proposed Order Reminder
1. When opening a chart that has a proposed order the following alert will fire.
2. Click the
button to clear the alert – it doesn’t accept the proposed order.
If you are not part of the MRP team and this proposed order is not within your
decision-making scope to accept or reject, disregard this alert.
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Quick Check Box for Proposed Ordering
Quick Orders Page
The Quick Orders page is specifically designed for the emergency department, enabling
providers to quickly place orders with a single click.
1. Click the Quick Orders component of the table of contents menu.
2. Define your view the first time by clicking the down-arrow beside View Selector and
clicking the correct view, depending on patient type.
3.
4. Click to place a checkmark in front of the desired orders in any of the available
components, e.g., ED Laboratory Investigations Adult.
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5. The selected orders will appear in the New Order Entry component, under Orders
for Signature.
6. Once orders have been added to Orders for Signature, you may choose to modify
them, if needed, remove them or sign them.
7. Clicking Modify opens the Order Details screen.
8. Click Sign to complete the order entry process.
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9. Please note that if something that you would like to order is not on this Quick Orders
page, you can simply search for the item in the New Order Entry component
without leaving the page.
Ordering Recurrent Transfusions in Outpatient Settings
This is to assist in ordering the COMMON – Recurrent Packed Red Blood Cells and
Platelets (Multi-Phase) PowerPlan.
Adding the Plan
1. In the Add Order window search and select the COMMON – Recurrent Packed Red
Blood Cells and Platelets (Multi-phase) PowerPlan.
2. The Add Plan window will display.
3. Enter in the estimated date you would like the recurrent transfusion to begin.
4. If a phase is not required (e.g. patient does not require platelet transfusions) then
change the Plan for a later date to Do not Order from the drop-arrow.
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5. Click the
button and click the
button.
Timing and Parameters Phase
The Timing and Parameters phase contains all the instructions that Nurses and
Laboratory Technicians require to complete this plan appropriately. All instructions
should be contained within this phase.
Timing of Infusion Order
The Timing of Infusion order contains three default sentences from the drop-down
menu for Mon,Thurs, Tues,Fri or weekly transfusions. Select the appropriate sentence
and enter in the desired number of weeks for possible transfusions in the Duration field.
If the required frequency is not available as one of the defaults, select the drop-arrow to
find the desired frequency.
The Laboratory orders will also be completed on this same schedule based on the
Communication order.
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Conditional If/Then Orders
The most common transfusion parameters have been included in the Conditional
If/Then orders. Select the appropriate transfusion parameter for your patient.
If the required parameter is not available right-click on Conditional If/Then order and
select Modify.
The parameters in the If/Then fields can be changed to meet the patients required
transfusion parameters.
Important: All parameter instructions for Nursing or Laboratory staff are to be
communicated through the Timing and Parameters phase. Please do not
enter Nursing transfusion parameters in other phases of the plan.
Laboratory Phase
The laboratory phase contains a Group and Screen and Complete Blood Count and
Differential to be completed prior to each transfusion.
If additional blood work is required select Add to Phase and Add Order to search for
required blood work.
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Packed Red Blood Cells and Platelets Phases
Right-click on the ADULT: Packed Red Blood Cells (PRBC) or ADULT: Platelets (PLT)
order and select Modify Planned Order.
Complete the Rate of Infusion (each unit over) and Reason for PRBC transfusion fields.
Important: Do not enter transfusion parameters intended for Nursing staff in this order.
This order is for Blood Transfusion Lab only. Please use the Conditional
If/Then order for Nursing related information.
Select any PreTransfusion or PostTransfusion medications required.
Completing the PowerPlan
Once all information has been completed, click the
button.The plan phases should display as below.
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View Planned PowerPlan
If you are looking for planned orders, open the Orders page. They will be displayed at
the top of the View section under Plans. You may need to click the (+) plus signs beside
Plans to be able to see all plans.
ORDER ALERT
In the current configuration of HUGO, more than one provider was able to enter orders
on a patient's chart at the same time. We had put this preference in place to reduce
frustration among providers if there is simultaneous ordering activity taking place, e.g.,
MRP and consulting services.
However, we have found that with a simultaneous order, when you place an IV order,
the system does not perform allergy checking for the IV medication.
This means if a patient was allergic to morphine and a morphine IV infusion was
ordered, there would be no allergy checking.
As a patient safety precaution, we have turned the setting that allows simultaneous
provider order entry OFF. This will enable allergy checking but only allows one person in
the chart at a time.
You may see the above warning appear if you are attempting to enter orders on a
patient’s chart at the same time as someone else. This is a safety feature of the system
and helps us to ensure that two people are not entering orders at the same time –
which could result in dual orders for the same item.
If you click on Proceed and Notify, the system will allow you to continue adding orders
to the scratchpad or adding details to a PowerPlan, but will not allow you to sign those
orders until the first user has either signed their orders or left the scratchpad.
Please note, we are working on the solution to this issue which will be included in the
system when we upgrade the Cerner system in the fall.
ORDERS PAGE
It is recommended that users keep the View pane open in their Orders page. This allows
for quicker viewing of PowerPlans available on the patient and order categories for
quicker navigation of the orders page.
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If yours is not visible, click on the arrow to open it.
PATIENT LISTS
The process for adding and removing a patient is unchanged from your current practice.
Some patient lists are maintained by the system and automatically add new admissions
and remove transfers or discharges. However, you can also build custom patient lists
that might be more relevant to your workflow or role
Custom list patient entries are not generated automatically. You may need to manually
add or remove patients from a custom list.
Build a Location List
1. From the Patient List toolbar, click the List Maintenance
icon.
2. The Modify Patient Lists dialog box opens.
3. It displays Available lists: on the left an Active lists: on the right.
4. To create a new list, click the
button.
5. The Patient List Type dialog box opens. Double-click Location.
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6. The Location Patient List dialog box opens.
7. Click the plus sign in front of Locations.
Please note that you can also choose Locations Groups to generate a list of patients
admitted to a specific location within a predefined location, e.g., J Colp Clinic. We
won’t be doing that in our example.
8. Click the plus sign in front of the appropriate site location, e.g., LHSC-UC.
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9. Click the plus sign in front of the appropriate building location, e.g. UH Main.
10. Click the checkbox for desired nursing unit location (or ambulatory location).
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denotes nursing unit location
denotes ambulatory location
11. Click the
button.
12. The Modify Patient Lists dialog box displays.
13. Click to highlight the new list name in the Available lists: pane and then click the
blue arrow to move the name to the Active lists: pane.
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14. Click the
button to return to the Organizer screen.
You can modify the order of the lists using the up
and down
arrows.
15. The new list now appears as its own tab with all patient names automatically
generated for that location.
Build a Relationship List
You can build a patient list based on your established relationship to the patient. For
example, if you are identified as the admitting physician, the patient’s name is
automatically displayed when you build the relationship list.
In this example, we will show a provider the steps to build the Relationship List and
grant proxy to this list to a medical secretary.
There are three steps in the creation of a Relationship List for the provider > medical
secretary workflow:
1. The provider needs to create the list;
2. The provider then grants the medical secretary Proxy Access to the list;
3. The medical secretary moves this list to the Active lists in the Modify Patient Lists
window.
Step 1 – Provider Creates a Relationship List
1. From the Patient List toolbar, click the List Maintenance
icon.
2. The Modify Patient Lists dialog box opens.
3. It displays Available lists: on the left an Active lists: on the right.
4. To create a new list, click the
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5. The Patient List Type dialog box opens. Double-click Relationship.
6. The Relationship Patient List dialog box opens.
7. Type a name for your list in the Enter a name for the list field.
Choose Visit Relationships
1. Next, click the plus sign in front of Visit Relationships to expand this.
2. From the Visit Relationships list, click in the checkbox to choose your relationship,
e.g., Admitting Physician and Attending Physician.
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Choose Encounter Types
1. Next click Encounter Types (on the left-hand side of the dialog box). There will be no
checkmark initially.
2. Click in the checkboxes to select appropriate encounter types, e.g., Inpatient,
Outpatient and One Day Stay.
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3. Click the
button.
Step 2 – Provider Grants Secretary Proxy to Relationship Patient List
1. The Proxy dialog box opens.
2. Click the
button.
3. Click the Provider radio button.
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4. Provider types secretary’s name for proxy and click the
icon.
5. The Provider Selection window opens.
6. Make sure the provider does not select any Limit by filters.
7. Click the name of secretary and click the
button.
8. You are returned to the Proxy dialog box.
9. Click the down-arrow beside the Access field and choose Read.
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10. In the To: field, set your date to 2100/01/01 and a time of 2359.
11.
12. Next click the
button.
13. The secretary’s name now appears under Name in the Proxy dialog box.
14. Click the
button.
15. You are returned to the Modify Patient Lists dialog box.
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16. Click the
button to return to the Organizer screen.
Step 3 – Secretary Logs in and Activates List
1. From the Patient List toolbar, click the List Maintenance
icon.
2. The Modify Patient Lists dialog box opens.
3. It displays Available lists: on the left an Active lists: on the right.
4. Click to highlight the relationship list name in the Available lists: pane and then click
the blue arrow to move the name to the Active lists: pane.
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5. Click the
button.
6. This list will appear as a new tab on the Organizer.
Build a Provider Group List
1. From the Patient List toolbar, click the List Maintenance
icon.
2. The Modify Patient Lists dialog box opens.
3. It displays Available lists: on the left an Active lists: on the right.
4. To create a new list, click the
button.
5. The Patient List Type dialog box opens. Double-click Provider Group.
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6. Click in the check box next to the Provider group in which you belong.
7. Next click Encounter Types (on the left-hand side of the dialog box). There will be no
checkmark initially.
8. Click in the checkboxes to select appropriate encounter types you wish to see.
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9. Click the
button.
10. Click the
button.
11. The Modify Patient Lists dialog box displays.
12. Click to highlight the new list name in the Available lists: pane and then click the
blue arrow to move the name to the Active lists: pane.
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13. Click the
button to return to the Organizer screen.
You can modify the order of the lists using the up
and down
arrows.
14. The new list now appears as its own tab with all patient names automatically
generated for that location.
Build a Medical Service List
Build a Medical Service list to show all patients admitted to a medical service. The
names are displayed automatically. Patient entries cannot be added or removed from
the list.
1. From the Patient List toolbar, click the List Maintenance
icon.
2. The Modify Patient Lists dialog box opens.
3. It displays Available lists: on the left an Active lists: on the right.
4. To create a new list, click the
button.
5. The Patient List Type dialog box opens. Double-click Medical Service.
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6. Click in the appropriate checkbox for the medical service you require.
7. Click the
button.
8. The Modify Patient Lists dialog box displays.
9. Click to highlight the new list name in the Available lists: pane and then click the
blue arrow to move the name to the Active lists: pane.
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10. Click OK to return to the Organizer screen.
11. The new list now appears as its own tab with all patient names automatically
generated for that medical service.
Build a Personal / Custom List
A Personal/Custom list might be helpful to follow up on patients. It is also useful for
inpatient nurses so they only display their patient assignments on the Patient Access List
(PAL).
1. From the Patient List toolbar, click the List Maintenance
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icon.
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2. The Modify Patient Lists dialog box opens.
3. It displays Available lists: on the left an Active lists: on the right.
4. To create a new list, click the
button.
5. The Patient List Type dialog box opens. Double-click Personal/Custom.
6. The Custom Patient List dialog box opens.
7. Type a name for the list and specify a filter type (if applicable), e.g. My Follow-up
List, My PAL.
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8. Click the
button.
9. The Modify Patient Lists dialog box displays.
10. Click to highlight the new list name in the Available lists: pane and then click the
blue arrow to move the name to the Active lists: pane.
11. Click the
button to return to the Organizer screen.
You can modify the order of the lists using the up
and down
arrows.
12. The new list now appears as its own tab but no patient names are generated. You
need to add the patients to a custom list.
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Add a Patient to a Custom List
You cannot add or remove patients to Location or Medical Service list types.
Method 1 – Patient Search
1. Make sure you have clicked your custom patient list tab.
2. From the Patient List toolbar, click the Add Patient
icon.
3. The Patient Search window opens.
4. Enter the appropriate search criteria and click Search to retrieve matching entries.
5. Select the correct patient and encounter and then click the
6. If prompted, assign a relationship and click the
button.
button.
7. The patient is added to your custom list.
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8. Repeat the steps to add additional patients.
Method 2 – When a Patient Chart is Open
When a patient chart is open, click Patient on the menu bar and select Add Patient to a
Patient List and then click the desired custom list.
Method 3 – Add From Another Patient List
Right-click on a patient on another list and choose Add to a Patient List and click the
desired custom list. (If you have more than one list.)
Remove a Patient from a Custom List
You cannot add or remove patients to Location or Medical Service list types.
1. Open the patient list.
2. Select the patient’s name to be removed from the list.
3. From the Patient List toolbar, click the Remove Patient
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4. The patient’s name is no longer displayed on the patient list.
Print a Custom List
1. From your custom list, click the Task menu on the menu bar.
2. Click Print and then click Print Screen.
3. Make sure the correct printer is selected and then click OK.
POWERPLAN FAVORITES
When modifications are made to a PowerPlan you will be prompted to resave your
favorite plan. This guide will assist with the resaving of a PowerPlan favorite.
Notification of Plan Modifications
After modifications have been made to a Standard Catologue Plan you will be notified
when accessing the PowerPlan from your plan favorites. The Plan Favorite Notification
window will open and identify any changes that have been made. Review all changes
that have been made carefully before proceeding.
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If you would like to continue to use your favorite plan click Continue.
If an orderable was preselected in your favorite plan you may receive a Load My
Favorite alert notification stating that the order is no longer available.
Click OK to proceed to the plan.
Reviewing the Plan
Review the Plan favorite for the identified modifications. Ensure the new order is either
included or excluded as desired and complete order details. All other orders will remain
unchanged from the previous plan favorite.
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In this example the LAB – Group and Screen Module was replaced with the Group and
Screen single orderable.
Resaving the Plan
After reviewing the new plan select
to resave this plan. The Save as
My Favorite dialog box will display with the current Plan Favorite Name.
The same plan name may be used when resaving personal favorites. A Save as My
Favorite alert window will notify you that the previous plan favorite will be lost.
Click
to complete the saving of your new favorite plan.
Removing Favorite PowerPlans
If a PowerPlan favorite is no longer needed it may be removed from the My Favorite
Plans Folder. From the Add Order window click the
Plans.
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icon and select My Favorite
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A list of your favorite plans will display. Right-click on the PowerPlan you would like to
remove from your favorites.
Click Remove Plan.
A Remove Plan alert dialog box will open to confirm the removal of the PowerPlan from
the favorite folder.
Click
to remove the plan.
PRESCRIPTIONS
Do Not Print a Duplicate Prescription for the Chart
There is no need to print a prescription twice for hospital records. Once a prescription is
issued the record of the prescription is captured and available for viewing in the system.
Non-Medication Template Prescription
Changes have been made to the non-medication template to increase the ease of use
when prescribing.
Previous Non-Medication Template
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New Non-Medication Template
If you search by non-medication template, you will now get the new version and this
will continue to be used if the orderable does not have a specific template already prebuilt that is suitable for use.
Specific Non-Medication Template
Currently, seven new templates have been set up for common non-medication
prescriptions.
1. Crutches
2. Wig
3. Glucometer
4. Physiotherapy
5. Syringes
6. Wheel chair
7. Ankle foot orthosis
If you search by a specific orderable, i.e., ankle foot orthosis, you will get the new
template that appears on the printed script and is easier to understand for the patient.
1. Search for the specific orderable name and click the appropriate orderable – it will
turn bold and blue.
Note: When searching for these new templates, the orderable is indented.
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2. Click the
3. The
button.
indicates incomplete order details.
4. The Dose field is a required field. Select See Instructions from the drop-down or
free-text the dose.
5. The Special Instructions field is a required field. Free-text the desired additional
information for the prescription.
Important: The Dispense field is no longer a mandatory field but may be required
for insurance purposes, depending on the item.
6. When all order details are complete, click the
screen.
button and refresh the
7. When a specific orderable non-medication template is used, the printed prescription
now appears as the following:
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Narcotic Prescriptions
Prescriptions for narcotics have been designed to print off on a separate page as
community pharmacies have legislative requirements to store narcotic prescriptions for
longer periods than regular prescriptions.
Placing an Ambulatory Medication Order as a Prescription
1.
2.
3.
4.
Open the patient’s chart to the Orders page.
Click the
icon.
The Add Order window opens.
Ensure you change the Type field from Ambulatory to Ambulatory (Meds as Rx).
5. In the Find field, type the drug name and select the closest match – it will turn bold
and blue.
6. Select the order sentence closest to the order intended and click the
button.
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7. Click the
button.
8. Complete the order details as required/needed.
9. Make sure that the Send To: field is displaying your default printer.
10. Click the
button and refresh your screen.
Important: Once you click the
default printer.
button, the prescription is printed to your
Prescription on Discharge
The Special Instructions field in the Prescription details is a field that allows you to add
details on the prescription instructions. You can add instructions such as:
•
Instruction for the pharmacist filling the prescription such as holding a
prescribed medication until it is approved by family physician.
•
Instructions to be added to the medication label such as detailing the range
dosing of medication 1 to 2 tabs.
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Print a Prescription for an Inpatient Medication
A Provider can generate a prescription for an inpatient medication order without going
through discharge medication reconciliation.
Important: By generating the prescription in this manner, the patient’s discharge
medication reconciliation will not necessarily be reflective of all of his/her
discharge medications.
1. Open the patient’s chart to the Medication List component of the table of contents
menu.
2. Right-click on the inpatient medication order and choose Convert to Prescription.
3. Complete the order details as required/needed.
4. Make sure that the Send To: field is displaying your default printer.
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Important: Providers should convert all the medications they want on the prescription
first and only click the
button when they are done, so all the
medications are batched together.
5. Click the
6. Click the
button.
button and refresh your screen.
Important: Once you click the
default printer.
button, the prescription is printed to your
A provider can generate a prescription for an inpatient medication order without going
through discharge medication reconciliation.
Important: By generating the prescription in this manner, the patient’s discharge
medication reconciliation will not necessarily be reflective of all of his/her
discharge medications.
7. Open the patient’s chart to the Medication List component of the table of contents
menu.
8. Right-click on the inpatient medication order and choose Convert to Prescription.
9. Complete the order details as required/needed.
10. Make sure that the Send To: field is displaying your default printer.
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Important: Providers should convert all the medications they want on the prescription
first and only click the
button when they are done, so all the
medications are batched together.
11. Click the
button.
12. Click the
button and refresh your screen.
Important: Once you click the
button, prescription is printed to your default printer.
Print a Prescription Through Juniper
In most cases, printers directly connected to external computers with a Windows 7 or
Windows XP operating system are accessible from a Juniper Citrix Cerner session.
Print a Prescription Using a Tablet
You will need to convert the medication to a prescription and then setup the printer on
the tablet.
Convert and Print Prescription
1. Using the tablet, open the patient’s chart in PowerChart.
2. Find and touch and hold the medication.
Reprint a Prescription
To reprint one or more prescriptions
1. Highlight the prescription medication in the Home Medications widget of the
Summaries ViewPoint.
2. Click the
3. Click the
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button.
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4. Click Medication List from the table of contents menu.
5. Right-click the medication.
6. Click Convert to Prescription.
7. Click the ellipse button beside Send To:.
8. In the Prescription Routing window, ensure Send To has Printer selected.
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9. Click the Other Output Devices tab.
10. You may need to scroll down to see and click Unknown.
11. Find and select your printer under Device Name.
12. Click the
.button.
Unfortunately, printers connected to external Apple computers (Max OS X, iOS) are not
accessible at this time.
PRINTERS - CHANGING YOUR DEFAULT PRINTER IN WINDOWS
Windows 7
1. Click the Start button (
) and then click Devices and Printers.
2. Under Printers and Faxes, find the printer you want as default.
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3. Right-click on the printer and select Set as default printer.
4. You'll see a check mark on the printer's icon, signifying that it's now your default
printer.
Windows XP
1. Click the Start button and then click Settings and click Printers and Faxes.
2. Find the printer you want as default.
3. Right-click on the printer you want as default and select Set as Default.
Thin Clients
A Client Support person will need to do this, as it requires a special login and password.
Contact the HelpDesk.
RECORD WHY YOU WERE IN A PATIENT’S CHART
We encourage that only Regulated Health Professionals who are in the patient’s circle of
care go into a patient’s chart. It is recommended, for auditing reasons, to record why a
patient’s chart has been accessed, e.g., reviewing a medication request from Pharmacy
after discharge.
1. From the menu bar, click Chart.
2. Click Chart Accessed By and then click Most Recent.
3. In the Chart Access Log window, find your name in the Most Recent Chart Accessed
Per Provider list.
4. Click in the Comment field beside your name and type the reason you are accessing
the patient’s chart.
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5. Click the
button.
6. Click the
button.
Important:
Do not use a Sticky Note in PowerChart to record chart access.
SURGERY – BOOKING YOUR PATIENT FOR SURGERY
Complete Surgical Procedure Request Form
1. Complete Surgical Procedure Request form
(https://apps.lhsc.on.ca/regional/training/powerchart/assets/HUGO/JobAids/Sugical
ProcedureRequestForSecBooking.pdf ) and give to your secretary (replaces the top
portion of the previous Pre Admit preprinted order sheet).
2. If you need a PAC visit with anesthesia or internal medicine, you must indicate that
on the Surgical Procedure Request form so that the appropriate PAC visit is booked.
(You still need to order the consult in the Periop-Pre Admission Clinic PowerPlan.)
3. Validate that allergies are entered.
If allergies are not documented electronically, you cannot proceed with order entry
as it is a hard stop.
Enter Pre-Admission PowerPlan
1. From your patient’s chart, click Add in the Orders component of the table of
contents menu.
2. The Add Order window opens.
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3. In the Find field, type periop - to see the PERIOP PowerPlans, or ortho – to
see the ORTHO PowerPlans.
4. Click to select either the PERIOP – Pre-Admission Clinic PowerPlan or ORTHO – PreAdmission Clinic PowerPlan – it will turn bold and blue.
5. Click the
button.
6. Select the orderables that are appropriate for the procedure by clicking the check
boxes to left of the orderable.
7. Ensure that you have included the following:
a. Diagnostic tests including blood work and x-rays - for Ortho patients, use the
ORTHO – Pre-Admission Clinic PowerPlan and you will find all the x-rays listed;
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b. Anesthesia and Medicine consults with reason included;
c. Complete all required details (yellow highlighted fields) for all orders, there is
only one exception – DO NOT choose a label printer if requested.
NEVER, EVER click the
button to initiate the PowerPlan –click the
button only to put the PowerPlan into a Planned state.
Enter Day of Procedure PowerPlan
Once you have the pre admission clinic orders complete then proceed to Day of
Procedure orders.
1. From your patient’s chart, click Add in the Orders component of the table of
contents menu.
2. The Add Order window opens.
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3. In the Find field, type periop - to see the PERIOP PowerPlans, or ortho – to
see the ORTHO PowerPlans.
4. Click to select either the PERIOP – Day of Procedure, Pre-Op PowerPlan or ORTHO –
Day of Procedure, Pre-op PowerPlan – it will turn bold and blue.
5. Click the
button.
6. Select the orderables that are appropriate for the procedure by clicking the check
boxes to left of the orderable.
7. Ensure that you have included the following:
a. IV insertion order, with the appropriate limb selected or no preference;
b. IV fluid order with desired rate;
c. IV antibiotics, with Send to OR or Start on Transfer from PREP to OR in the Order
Comments tab.
d. Vital signs and NPO are pre-selected.
e. Intraoperative Portable is used when you require an xray(s) in the room during a
procedure (such as fluoroscopy).
8. A down-arrow in the middle of the page means that there are various order
sentences that you can choose to complete your order, i.e., IV rate, drug dosing.
9. Click the down-arrow and select the correct order sentence.
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Add an Order to a PowerPlan
1. If an order does not exist in the PowerPlan, add single orders by selecting Add to
Phase.
2. Click Add to Phase and then click Add Order to open the Add Order window.
3. Consider which of the following types of orders it may fit.
a. Is there an actual orderable that matches, i.e., medication or lab test?
b. Is it a Communication order? In the Find field, type communication and
select Communication Order. Type the exact words of the order in the Enter
verbatim order field of the Order details.
c. Is it a Conditional If/Then order? In the Find field, type Conditional and
select the Conditional If/Then order. Complete the required If and Then fields
(conditions).
d. Is it a Notify Provider order? In the Find field, type Notify Provider-and
select the appropriate Notify Provider order and completed the order details.
e. Is it diabetic orders PPO from UH? Use a combo of the above and add a
Communication Order to ‘see paper orders’.
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4. DO NOT SAVE a PowerPlan as a favorite with the IV solution included –
unfortunately, this is broken functionality and will just result in a blank line item
where the IV solution should be.
5. SAVING PowerPlans as favorites can help streamline your workflow. However, if
changes are made to the base PowerPlans, your favorite could change or be
unavailable and need to be recreated.
6. Just to clarify, any plans in a planned state for patients are NOT affected.
NEVER, EVER click the
button to initiate the PowerPlan –click the
button only to put the PowerPlan into a Planned state.
TRANSFERS
If a patient from a Cerner hospital is transferred and does not have a Patient Summary printout
with them, alternate print outs are available:
Print the Transfer Medication Administration Report
1. To find the previous encounter for the patient click the Location: link on the
Demographics Bar.
2. Double-click on the desired encounter and click the
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3. Click the Task menu and then click Reports.
4. Check off the Transfer Medication Administration.
5. Complete From: and To: date and time.
6. Select Printer destination.
7. Click the
button.
Transfer Between Campuses
Transfer to LHSC UH and Transfer to LHSC VH has been built in the system. This order is
to be used by providers to alert nursing and unit clerks to an impending transfer.
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VIEW LABORATORY GUIDES AND TESTS
1. Click Manuals and Guides on the LHSC Intranet site.
2. Type lab in the Filter field.
3. Click Laboratory Test Information Guide.
Click Browse all test.
4. Click a Jump to, to narrow down the search.
5. Click on the test.
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POWERCHART ICON LEGEND
PowerChart Icon Legend
Patient Access List (PAL)
Allergies documentation
No allergies documentation
No known allergies documentation (Region only)
Patient has a continuous IV order
New routine priority orders requiring nurse review
New stat priority orders requiring nurse review
New routine priority orders that do not require nurse review
New routine results
New critical results
Patient care task
Lab test task
Medication task
Stat medication task
MAR
Scan successful
Medication order not verified by Pharmacy
Medication order rejected by Pharmacy
Cross order interval checking has been turned off
Cosign by Provider needed
Required field not completed
Critical task, such as an overdose or unmatched drug
Additional charting may be required
Underdose
Unscheduled medication
Nurse review is required
MAR note (click to see comment)
Overdue task/medication
Order is part of an PowerPlan
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Orders
Denote an ambulatory order
Denotes an inpatient order
Inactive order
Active order
Collapse Details pane
Expand Details pane
Expand a clinical category
Collapse a clinical category
Order details not complete
Reference text information available
Cosign by Provider needed
Provider cosign refusal
Nurse review is required
Order is part of a PowerPlan
Proposed order pending approval
Order yet to be verified by Pharmacy
Order has been rejected by Pharmacy
Search or filter. Hover to view more information.
PowerPlan Interactive
Merges view of PowerPlan with current orders
Filters view in PowerPlan only to checked items in a planned PowerPlan
View excluded components in an initiated PowerPlan
Discontinue PowerPlan
Gateway to add orders to PowerPlan
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PowerChart Icon Legend
PowerForm
Sign form
Clear
Cancel
Clinical calculator
Previous (page)
Next (page)
Document Meds by Hx
Medication documented manually
Prescription entered by provider
Medication Reconciliation (MedRec)
Compliance documentation, e.g., Still taking not as prescribed
Prescription medication
Inpatient medication
Medication documented manually
Order not yet reconciled
Formulary drug
Non-Formulary drug
Order details not complete
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